The financial implications of availability and quality of a usual source of care for children with special health care needs.
OBJECTIVE
To examine the relationship of availability and quality of a usual source of care (USC) to medical expenditures overall and for various types of health care services for children with special health care needs (CSHCN), as a group and by four diagnostic subgroups (asthma, non-asthmatic physical conditions, mental retardation, other mental illnesses).


METHODS
Generalized linear models were used to estimate the annual average per capita medical expenditures (APCME) based on data from 820 CSHCN in the 1995 National Health Interview Survey on Disability and 1996 Medical Expenditure Panel Survey.


RESULTS
In 1996, 92% of non-institutionalized CSHCN in the United States had a USC. Of these, 52% were classified as receiving accessible care, 95% received comprehensive care, and 69% received satisfactory care. Approximately 89% of CSHCN had expenditures on health care in 1996 and the APCME was $1,344 for CSHCN as a group. Having a USC was associated with higher expenditures overall and for almost all types of health care services for CSHCN across conditions. Receiving comprehensive care was associated with lower total medical expenditures for CSHCN with asthma, whereas receiving satisfactory care was associated with higher total medical expenditures for CSHCN with non-asthma physical conditions.


CONCLUSIONS
Having a regular care provider is associated with higher expenditures for CSHCN across diagnosis. Among CSHCN with a USC, quality of care is associated with medical expenditures, although specific associations vary by the quality characteristic and the condition of the child. These results may mask heterogeneity in severity of condition and quality of care over time.
Liu
Chia-Ling
CL
Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Kresge Building 6th Floor, Boston, MA 02115, USA. liu_chialing@yahoo.com
Zaslavsky
Alan M
AM
Ganz
Michael L
ML
Perrin
James
J
Gortmaker
Steven
S
McCormick
Marie C
MC
D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000191:economics; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics*; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008607:Intellectual Disability / Q000191:economics; D016014:Linear Models; D008297:Male; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000191:economics*; D011787:Quality of Health Care / Q000191:economics*; D014481:United States