title: Family out-of-pocket health care burden and children's unmet needs or delayed health care.
abstract: OBJECTIVE
  To assess the relationship between family members' out-of-pocket (OOP) health care spending and unmet needs or delayed health care due to cost for children with and without special health care needs (SHCN).
  
  
  METHODS
  Data come from the Medical Expenditure Panel Survey, 2002-2009, and include 63,462 observations representing 41,748 unique children. The primary outcome was having any unmet needs/delayed care as a result of the cost of medical care, dental care, or prescription drugs. We also examined having unmet needs/delayed care due to cost for each service separately. Key explanatory variables were OOP spending on the index child and OOP spending on other family members. We estimated multivariate instrumental variable models to adjust the results for potential bias from any unobserved factors that might influence both other family OOP costs and the outcome variable.
  
  
  RESULTS
  An increase of other family OOP costs from $500 (50th percentile) to $3000 (90th percentile) was associated with a higher adjusted rate of any unmet need/delayed care due to cost (1.39% to 5.62%, P < .001, among children without SHCN; 3.17% to 7.87%, P = .01, among those with SHCN). Among children without SHCN, higher OOP costs among other family members were associated with higher levels of unmet needs or delays in medical, prescription drug, and dental care, while among children with SHCN, higher OOP costs among other family members was primarily associated with unmet or delayed dental care.
  
  
  CONCLUSIONS
  Programs and policies that reduce the OOP costs of family members other than the child may improve the child's access to care.
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minn. Electronic address: pkmandic@umn.edu.
authors.forename: Pinar
authors.initials: P
authors.lastname: Karaca-Mandic
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minn.
authors.forename: Sung J
authors.initials: SJ
authors.lastname: Choi-Yoo
authors.affiliation: Department of Economics, Sungkyunkwan University, Seoul, Korea.
authors.forename: Jinhyung
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minn.
authors.forename: Peter
authors.initials: P
authors.lastname: Scal
mesh_terms: D002648:Child; D002671:Child, Exceptional; D017281:Cost of Illness; D019988:Children with Disabilities; D005192:Family Health / Q000191:economics*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D020380:Needs Assessment; D014481:United States
keywords: access; children's health care access; children's unmet needs/delayed needs; family out-of-pocket burden; out of pocket costs; unmet needs