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Children's Health

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Children with special health care needs generally use more health services and have higher costs than other children

An estimated 11 million U.S. children younger than 18 years had a special health care need in 2000. Children with special health care needs (CSHCN) are those who have chronic physical, developmental, behavioral, or emotional problems and require more or more complex care than other children. Not surprisingly, the family financial burden of caring for CSHCN is substantial.

A new study shows that in 2000, CSHCN had three times the health care expenditures of other children ($2,099 vs. $628). Although CSHCN account for less than 16 percent of U.S. children, they accounted for 52.5 percent of children's hospital days in 2000. In addition, CSHCN accounted for 42 percent of total medical care costs (excluding dental costs) and 34 percent of total health care costs (including dental costs) attributed to children in 2000.

CSHCN used five times as many prescription medications per year and used substantially more home health provider days than other children. Insurance plays an important protective role for families of CSHCN, but it provides incomplete protection, with impoverished families of CSHCN bearing the greatest financial burden. On average, out-of-pocket expenses for CSHCN were about twice those of other children. Families of CSHCN experiencing high out-of-pocket expenses (exceeding 5 percent of family income) were much more likely to be from impoverished households than from nonpoor households.

Given that out-of-pocket expenses for CSHCN are much higher than other children, wrap-around insurance policies that improve financial protection for services like ambulatory care, prescription medications, and dental care would be of great value to families of CSHCN, suggests Paul W. Newacheck, Dr.P.H., of the University of California, San Francisco. Dr. Newacheck and his colleague Sue E. Kim, Ph.D., based their findings on analysis of data from AHRQ's Medical Expenditure Panel Survey (2000). Their work was supported by a cooperative agreement between the Agency for Healthcare Research and Quality and the Health Resources and Services Administration's Maternal and Child Health Bureau.

See "A national profile of health care utilization and expenditures for children with special health care needs," by Drs. Newacheck and Kim, in the January 2005 Archives of Pediatric and Adolescent Medicine 159, pp. 10-17.

Editor's Note: Another AHRQ-supported study on a related topic shows that urban community stressors—such as unemployment, violence, and poverty—may contribute to behavioral and emotional problems among CSHCN. For more details, see Jaffee, K.D., Liu, G.C., Canty-Mitchell, J. and others (2005, January). "Race, urban community stressors, and behavioral and emotional problems of children with special health care needs." (AHRQ grant HS10453). Psychiatric Services 56(1), pp. 63-69.

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