Health care access for children with special health care needs in California.
OBJECTIVE
This study examines health care access for children with special health care needs (CSHCN) in California, one of the nation's most populous and diverse states.


METHODS
Data are from the National Survey of Children with Special Health Care Needs (NS-CSHCN), a nationally representative survey of access for U.S. children fielded by the National Center for Health Statistics (NCHS). California CSHCN and those in California's Medicaid program are compared with CSHCN elsewhere on child health need, family enabling factors, health care enabling factors, system outcomes, and children's experiences with care. Multivariable analysis identifies family and health care factors associated with system outcomes and children's experiences with health care.


RESULTS
California parents generally report poorer experiences with care, lower performance on systems outcomes, and fewer health care and family enabling factors. The magnitude of disparity is greatest for CSHCN in Medi-Cal, although lower-income privately insured CSHCN in California also have poorer access than their counterparts in other states. Among CSHCN in Medicaid, greater condition impact and adolescent age are associated with poorer experiences in California for most measures. Disparities between California and other states persist even adjusting for family and health care factors in multivariable analysis.


CONCLUSIONS
Performance gaps in California stem from population differences and apparent administrative barriers. Several statewide initiatives are addressing system barriers through supports to providers and information to parents.
Department of Health Services, UCLA School of Public Health, Center for Healthier Children, Families, and Communities, Los Angeles, California, USA. minkelas@ucla.edu
Moira
M
Inkelas
Kathryn A
KA
Smith
Alice A
AA
Kuo
Linda
L
Rudolph
Susan
S
Igdaloff
D002140:California; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data; D002675:Child, Preschool; D003625:Data Collection; D019988:Children with Disabilities; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007348:Insurance, Health / Q000145:classification; D008484:Medicaid; D011787:Quality of Health Care; D014481:United States