title: Association between underinsurance and access to care among children with special health care needs in the United States.
abstract: OBJECTIVE
  To examine the impact of underinsurance on access to care among children with special health care needs (CSHCN) in the United States.
  
  
  METHODS
  Interviews were conducted by telephone with the families of 38866 CSHCN who were younger than 18 years using the 2001 National Survey of Children With Special Health Care Needs. The prevalence of underinsurance and its relationship to access to care and family financial problems was examined in this cross-sectional analysis. CSHCN were classified as underinsured when coverage was deemed inadequate to meet the child's needs.
  
  
  RESULTS
  An estimated 12.8% of US children experienced a special health care need in 2001. Although 95% of CSHCN had some type of insurance coverage at the time of the interview, 32% were classified as underinsured. Underinsured CSHCN were disproportionately represented in low-income families and were significantly more likely than fully insured children to have unmet health needs, and their families were more likely to report difficulty in obtaining specialty referrals, experience financial problems, and report that the child's condition caused family members to reduce or stop work. Underinsured CSHCN seemed to be somewhat better off than CSHCN with no insurance coverage on these measures.
  
  
  CONCLUSIONS
  Underinsured CSHCN represent an important and largely hidden underserved population.
authors.affiliation: Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD 20857, USA. mkogan@hrsa.gov
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kogan
authors.forename: Paul W
authors.initials: PW
authors.lastname: Newacheck
authors.forename: Lynda
authors.initials: L
authors.lastname: Honberg
authors.forename: Bonnie
authors.initials: B
authors.lastname: Strickland
mesh_terms: D002648:Child; D019988:Children with Disabilities; D005190:Family; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D014481:United States