title: Role of insurance for children with special health care needs: a synthesis of the evidence.
abstract: OBJECTIVE
  Children with special health care needs constitute a particularly vulnerable subpopulation of children. Health insurance coverage has the potential to enhance access to care and improve the quality of life for these children while protecting their families from financially burdensome health care expenses. The purpose of this review is to assess and synthesize recent research in the peer-reviewed literature pertaining to the role of insurance for children with special health care needs. A marked increase in the volume of research on this topic makes this an opportune time to summarize these contributions and begin the process of formalizing an evidence base that can inform health policy decisions. Our intention is to further the evidence base by providing a literature-driven assessment of the role of health insurance in influencing access, utilization, satisfaction, quality, expenditures, and health outcomes for children with special health care needs.
  
  
  METHODS
  A systematic literature review was conducted on the effects of insurance status, insurance type, and insurance features on access, utilization, satisfaction, quality, expenditures, and health status.
  
  
  RESULTS
  The strongest evidence emerged for the positive effects of insurance on access and utilization. Limited evidence on the effect of insurance on satisfaction with care showed improved satisfaction ratings for the insured. The studies with findings relevant to out-of-pocket expenditures for insured versus uninsured children with special health care needs all found significantly higher out-of-pocket burden and financial problems among the uninsured. Evidence was mixed for the effects of insurance type (public or private) and insurance characteristics (eg, managed care or fee-for-service payment mechanisms) on outcomes. None of the studies that we reviewed attempted to assess the impact of health insurance on health outcomes.
  
  
  CONCLUSIONS
  Our review of the literature found plentiful evidence demonstrating the positive and substantial impact of insurance on access and utilization. There also is clear evidence that insurance protects families against financially burdensome expenses. The evidence is less conclusive for satisfaction and quality and is nonexistent for health status. These latter outcomes should be the focus of future studies.
authors.affiliation: Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA.
authors.forename: Aimee E
authors.initials: AE
authors.lastname: Jeffrey
authors.forename: Paul W
authors.initials: PW
authors.lastname: Newacheck
mesh_terms: D000293:Adolescent; D002648:Child; D019988:Children with Disabilities; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011787:Quality of Health Care; D035862:Vulnerable Populations