The impact of insurance on satisfaction and family-centered care for CSHCN.
BACKGROUND
Children with special health care needs (CSHCN) have worse health outcomes and satisfaction compared with children with typical needs. Although individual characteristics influence satisfaction and family-centered care, additional effects of health insurance and state child health policies are unknown.


OBJECTIVE
To determine if satisfaction and family-centered care varied among CSHCN, after adjusting for individual characteristics, according to insurance type and state child health policies.


METHODS
We performed descriptive and multivariate analyses by using demographic, insurance, and satisfaction data from the 2006 National Survey of Children With Special Health Care Needs (N = 40723). Additional state data included Medicaid and State Children's Health Insurance Program (SCHIP) characteristics and the supply of pediatricians. We supplemented the national findings with survey data from Florida's SCHIP comprehensive care program (CMS-Duval ["Ped-I-Care"]) for CSHCN (N = 300).


RESULTS
Nationally, 59.8% of parents were satisfied with their child's health services, and two thirds (65.7%) received family-centered care. Adjusting for individual predictors, those uninsured and those with public insurance were less satisfied (odds ratios [ORs]: 0.45 and 0.83, respectively) and received less family-centered care (ORs: 0.43 and 0.80, respectively) than privately insured children. Of note, satisfaction increased with state Medicaid spending. Survey data from Ped-I-Care yielded significantly higher satisfaction (91.7%) compared with national levels of satisfaction in the SCHIP (54.2%) and similar rates of family-centered care (65.6%). These results suggest that satisfaction is based more on experiences with health systems, whereas family-centered care reflects more on provider encounters.


CONCLUSIONS
Insurance type affects both satisfaction and family-centered care for CSHCN, and certain state-level health care characteristics affect satisfaction. Future studies should focus on interventions in the health care system to improve satisfaction and patient encounters for family-centered care.
Thompson
Lindsay A
LA
Department of Pediatrics, University of Florida, College of Medicine, Gainesville, FL 32608, USA. lathompson@peds.ufl.edu
Knapp
Caprice A
CA
Saliba
Heidi
H
Giunta
Nancy
N
Shenkman
Elizabeth A
EA
Nackashi
John
J
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D022143:Family Nursing / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011640:Public Policy / Q000639:trends; D011787:Quality of Health Care / Q000706:statistics & numerical data; D014481:United States