Skinner Asheley Cockrell, Slifkin Rebecca T
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.
J Rural Health. 2007 Spring;23(2):150-7. doi: 10.1111/j.1748-0361.2007.00082.x.
To examine the barriers and difficulties experienced by rural families of children with special health care needs (CSHCN) in caring for their children.
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.
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.
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.
探讨有特殊医疗需求儿童（CSHCN）的农村家庭在照顾孩子过程中所面临的障碍和困难。
利用全国有特殊医疗需求儿童调查来研究城乡在医疗服务提供者类型、CSHCN未满足医疗需求的原因、遇到的保险和经济困难以及提供孩子医疗护理的家庭负担方面的差异。我们同时呈现未调整和调整后的结果，以便考虑城乡差异的原因。
与城市儿童相比，农村CSHCN看儿科医生的可能性较小。他们因交通困难或当地无法提供护理而更有可能存在未满足的医疗需求；在护理障碍方面几乎没有其他差异。农村CSHCN的家庭更有可能报告与孩子医疗需求相关的经济困难，并且更有可能在家中为孩子提供护理。
对未调整和调整后的优势比结果进行研究表明，农村CSHCN家庭的护理负担既源于社会经济差异，也源于卫生系统差异。旨在实现农村儿童公平的政策将需要关注个体因素和医疗保健基础设施，包括增加保险覆盖范围以减轻经济困难，并解决农村地区医疗服务提供者的可及性问题。
