School of Social Work (G Graaf), The University of Texas at Arlington, Arlington, Tex.
Department of Social Work (AN Palmer), Texas Christian University, Fort Worth, Tex.
Acad Pediatr. 2023 Aug;23(6):1204-1212. doi: 10.1016/j.acap.2022.10.020. Epub 2022 Nov 4.
Parents of children with special health care needs (CSHCN) report that private insurance is less adequate than public health coverage. Parents of CSHCN with emotional, behavioral, or developmental problems (EBDPs) may perceive private insurance to be especially inadequate due to higher need for a wider array of non-medical services and supports. This study's objective is to assess differences in parent ratings of insurance adequacy for public versus private health coverage between non-CSHCN, CSHCN, and CSHCN with EBDPs.
This study pooled publicly available data from the 2016 through 2019 National Survey of Children's Health. Multivariable fixed effects logistic regression models estimated the association between insurance type, CSCHN and EBDP status, and parent ratings of their child's insurance adequacy. Marginal effects were calculated for insurance type, CSHCN and EBDP status, and their interactions to estimate the size of the association.
Among all subgroups, consistently more parents with publicly insured children rated their insurance as adequate compared to those with private insurance. Parents of privately insured CSHCN with EBDPs rated their insurance as adequate at significantly lower rates than any other group of parents (55%)-including those with privately insured children without EBDPs (non-CSHCN= 67%; CSHCN = 63%) and all other parents with publicly insured children (non-CSHCN = 87%; CSHCN = 83%; CSHCN with EBDPs = 84%).
Future research should investigate if perceptions of insurance adequacy among families whose CSHCN has an EBDP aligns with reports of service access and unmet health care needs.
有特殊健康需求儿童（CSHCN）的父母报告说，私人保险不如公共健康保险充分。有情绪、行为或发育问题（EBDP）的 CSHCN 的父母可能会认为私人保险特别不足，因为他们需要更多种类的非医疗服务和支持。本研究的目的是评估非 CSHCN、CSHCN 和 EBDP 儿童的父母对公共和私人健康保险充足性的评价在公共保险和私人保险之间的差异。
本研究汇集了 2016 年至 2019 年全国儿童健康调查中公开可用的数据。多变量固定效应逻辑回归模型估计了保险类型、CSCHN 和 EBDP 状况与父母对其子女保险充足性的评价之间的关联。计算了保险类型、CSCHN 和 EBDP 状况及其相互作用的边际效应，以估计关联的大小。
在所有亚组中，父母对公共保险覆盖的孩子的保险评价为充足的比例始终高于私人保险。与其他任何群体的父母相比，私人保险覆盖的 EBDP 儿童的父母对其保险的评价为充足的比例明显较低（55%）-包括私人保险覆盖的无 EBDP 儿童（非 CSHCN=67%；CSHCN=63%）和所有其他公共保险覆盖的儿童的父母（非 CSHCN=87%；CSHCN=83%；CSHCN 伴 EBDP=84%）。
未来的研究应该调查 EBDP 儿童的家庭对保险充足性的看法是否与服务获取和未满足的医疗保健需求的报告一致。
