Reasons for Unmet Need for Child and Family Health Services among Children with Special Health Care Needs with and without Medical Homes

Jane E Miller,Dorothy Gaboda,Louise B Russell,Colleen N Nugent,Waldemar A Carlo

doi:10.1371/journal.pone.0082570

Jane E Miller, Dorothy Gaboda + Show 3 more

Open Access

https://doi.org/10.1371/journal.pone.0082570

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Journal: PLoS ONE	Publication Date: Dec 10, 2013
Citations: 53	License type: CC BY 4.0

Affiliation: Rutgers, The State University of New Jersey

Abstract

ObjectivesMedical homes, an important component of U.S. health reform, were first developed to help families of children with special health care needs (CSHCN) find and coordinate services, and reduce their children’s unmet need for health services. We hypothesize that CSHCN lacking medical homes are more likely than those with medical homes to report health system delivery or coverage problems as the specific reasons for unmet need. MethodsData are from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN), a national, population-based survey of 40,723 CSHCN. We studied whether lacking a medical home was associated with 9 specific reasons for unmet need for 11 types of medical services, controlling for health insurance, child’s health, and sociodemographic characteristics. ResultsWeighted to the national population, 17% of CSHCN reported at least one unmet health service need in the previous year. CSHCN without medical homes were 2 to 3 times as likely to report unmet need for child or family health services, and more likely to report no referral (OR= 3.3), dissatisfaction with provider (OR=2.5), service not available in area (OR= 2.1), can’t find provider who accepts insurance (OR=1.8), and health plan problems (OR=1.4) as reasons for unmet need (all p<0.05). ConclusionsCSHCN without medical homes were more likely than those with medical homes to report health system delivery or coverage reasons for unmet child health service needs. Attributable risk estimates suggest that if the 50% of CSHCN who lacked medical homes had one, overall unmet need for child health services could be reduced by as much as 35% and unmet need for family health services by 40%.

Highlights

In 2007 the major primary care professional organizations in the U.S proposed the patient-centered medical home as an important component of health reform, a proposal which was quickly endorsed by health plans, employers, and medical specialty groups [1,2,3]
Lack of a medical home was associated with higher unmet need due to lack of referrals, dissatisfaction with services, transportation problems or unavailability of the service in the respondent's area, difficulty finding a health care provider who accepts the child’s insurance, and health plan problems
These results suggest that medical homes may play a role in helping families identify suitable providers, that they provide the necessary referrals, as they are expected to do, and that they appear to facilitate families' efforts to negotiate the health system

Summary

Introduction

In 2007 the major primary care professional organizations in the U.S proposed the patient-centered medical home as an important component of health reform, a proposal which was quickly endorsed by health plans, employers, and medical specialty groups [1,2,3]. Medical homes comprise a set of services that are expected to improve quality of care and reduce costs by coordinating patients’ care effectively and efficiently. They are seen as important for vulnerable populations with complex medical needs, including children in low-income, immigrant, and undocumented families [4], children identified through developmental screening as needing early intervention services [5], and adults with chronic conditions, especially those who need help with activities of daily living [6].

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