title: Rural/urban differences in barriers to and burden of care for children with special health care needs.
abstract: OBJECTIVE
  To examine the barriers and difficulties experienced by rural families of children with special health care needs (CSHCN) in caring for their children.
  
  
  METHODS
  The National Survey of Children with Special Health Care Needs was used to examine rural-urban differences in types of providers used, reasons CSHCN had unmet health care needs, insurance and financial difficulties encountered, and the family burden of providing the child's medical care. We present both unadjusted and adjusted results to allow consideration of the causes of rural-urban differences.
  
  
  RESULTS
  Rural CSHCN are less likely to be seen by a pediatrician than urban children. They are more likely to have unmet health care needs due to transportation difficulties or because care was not available in the area; there were minimal other differences in barriers to care. Families of rural CSHCN are more likely to report financial difficulties associated with their children's medical needs and more likely to provide care at home for their children.
  
  
  CONCLUSIONS
  Examining results from both unadjusted and adjusted odds ratios shows that the burden of care for families of rural CSHCN stems both from socioeconomic differences and health system differences. Policies aimed at achieving equity for rural children will require focusing on both individual factors and the health care infrastructure, including increasing insurance coverage to lessen financial difficulties and addressing the availability of providers in rural areas.
authors.affiliation: North Carolina Rural Health Research and Policy Analysis Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7590, USA. asheley@unc.edu
authors.forename: Asheley Cockrell
authors.initials: AC
authors.lastname: Skinner
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Slifkin
mesh_terms: D000293:Adolescent; D002648:Child; D017281:Cost of Illness; D019988:Children with Disabilities; D005190:Family; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data* / Q000639:trends; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D012111:Residence Characteristics; D019035:Rural Health Services / Q000191:economics* / Q000706:statistics & numerical data; D013997:Time Factors; D014186:Transportation; D014481:United States; D019037:Urban Health Services / Q000191:economics* / Q000706:statistics & numerical data