Family Financial Burden Research Articles

Medical Cost of Cancer Care for Privately Insured Children in Chile.

Medical care for children with cancer is complex and expensive, and represents a large financial burden for families around the world. We estimated the medical cost of cancer care for children under the age of 18, using administrative records of the universe of children with private insurance in Chile in the period 2007–2018, based on a sample of 3853 observations. We analyzed total cost and out-of-pocket spending by patients’ characteristics, type of cancer, and by service. Children with cancer had high annual medical costs, USD 32,287 on average for 2018. Costs were higher for the younger children in the sample. The vast majority of the cost was driven by inpatient hospital care for all types of cancer. The average total cost increased 20% in real terms over the period of study, while out-of-pocket expenses increased almost 29%. Private insurance beneficiaries faced a significant economic burden associated with medical treatment of a child with cancer. Interventions that reduce hospitalizations, as well as systemwide reforms that incorporate maximum out-of-pocket payments and prevent catastrophic expenditures, can contribute to alleviating the financial burden of childhood cancer.

Factor analysis of the relationship between PANSS score and family burden of patients with schizophrenia.

ObjectiveThis study aims to investigate the burden of family caregivers of patients with schizophrenia, and its influencing factorsMethodsA total of 105 patients with schizophrenia and their caregivers were investigated using the positive and negative symptom scale (PANSS) and family burden scale of disease (FBS)ResultsThere was a strong correlation between the patient's recovery and family burden, especially between positive and negative symptoms and family financial burden, family daily activities, family recreational activities, and family relationshipConclusionThere is a strong correlation between the patient's recovery and family burden, and this is especially correlated to family economic burden, family daily activities, family recreational activities, and family relationship. Medical staff should pay attention to the psychological characteristics of patients and fully understand and avoid the adverse effects of family burden on the rehabilitation of patients.

821 An Unusual Pediatric PAP Compliance Obstacle, Even When the Mask Fits

Abstract Introduction Proper mask fitting is an important factor for compliant and effective use of PAP therapy. However, we present 2 patients whose masks became a barrier to PAP therapy despite a well-fitting mask. Report of case(s) Case 1 A 12-year-old female with ADHD, Chiari I malformation status-post decompression, and persistent mixed central and obstructive sleep apnea is managed with BPAP S/T. Despite absence of upper airway structural abnormalities, she is a mouth-breather during sleep and only tolerates full face masks. Despite ensuring a good mask fit and optimal BPAP settings to control her AHI, she sleeps with her neck hyperextended, resulting in her lower jaw pushing caudally and the mask liner slipping into her mouth. This stimulated chewing and resulted in damage to several masks. Case 2 An 8-year-old male with congenital central hypoventilation syndrome is managed with BPAP S/T during sleep. Similar to case 1, he is a mouth-breather during sleep and can only tolerate full face masks. Although his mask and headgear fit him well, he drools in sleep which results in the silicone liner slipping into his mouth, stimulating chewing. This has led to the need for replacement of several masks. Of note, drooling did not occur when he was previously using assisted ventilation via tracheostomy, and bruxism was not identified during polysomnography. Conclusion To our knowledge, this is the first report of PAP mask chewing, thus its incidence is unknown. We suspect that the mask liner slipping into the mouth touches the anterior surfaces of the teeth stimulating the chewing reflex. The frequency of mask chewing and consequent damage is unpredictable and often necessitates mask replacement. Insurance companies should consider this unique mask complication when determining their mask coverage policies since the typical 6-months interval for authorization of a new mask can impair the patient’s health, PAP compliance, and become an out-of-pocket financial burden for families. Although it did not occur in our patients, mask chewing may pose a potential choking hazard. Awareness of mask chewing may help in improving pediatric PAP mask development to ensure masks are safe. Support (if any):

Patient and family financial burden associated with cancer treatment in Canada: a national study

GoalTo determine patient-reported financial and family burden associated with treatment of cancer in the previous 28 days across Canada.MethodsA self-administered questionnaire (P-SAFE v7.2.4) was completed by 901 patients with cancer from twenty cancer centres nationally (344 breast, 183 colorectal, 158 lung, 216 prostate) measuring direct and indirect costs related to cancer treatment and foregone care. Monthly self-reported out-of-pocket-costs (OOPCs) included drugs, homecare, homemaking, complementary/ alternative medicines, vitamins/supplements, family care, accommodations, devices, and “other” costs. Travel and parking costs were captured separately. Patients indicated if OOPC, travel, parking, and lost income were a financial burden.ResultsMean 28-day OOPCs were CA$518 (US Purchase Price Parity [PPP] $416), plus CA$179 (US PPP $144) for travel and CA$84 (US PPP $67) for parking. Patients self-reporting high financial burden had total OOPCs (33%), of CA$961 (US PPP $772), while low-burden participants (66%) had OOPCs of CA$300 (US PPP $241). “Worst burden” respondents spent a mean of 50.7% of their monthly income on OOPCs (median 20.8%). Among the 29.4% who took time off work, patients averaged 18.0 days off. Among the 26.0% of patients whose caregivers took time off work, caregivers averaged 11.5 days off. Lastly, 41% of all patients had to reduce spending. Fifty-two per cent of those who reduced spending were families earning < CA$50,000/year.ConclusionsIn our Canadian sample, high levels of financial burden exist for 33% of patients, and the severity of burden is higher for those with lower household incomes.

Transforming pediatric neuropsychology through video-based teleneuropsychology: an innovative private practice model pre-COVID-19

ObjectiveIn pediatric neuropsychology multiple barriers such as long wait times until an appointment, insurance coverage, and limited providers who are bilingual/bicultural or who sub-specialize in pediatric neuropsychology, often slow families from receiving diagnoses and interventions in a timely and affordable manner. This paper focuses on increasing accessibility through the development of a video-based, pediatric teleneuropsychology (TeleNP) practice model that was developed in a private practice 2 years before the COVID-19 pandemic.Method‘Design thinking’ methodology to problem-solving was utilized to innovate the traditional neuropsychology practice model in under-served areas who may have limited financial and healthcare resources. The practice model approach to include a virtual diagnostic clinic with increased patient and provider efficiency was created to enhance accessibility for patients and sustainability for providers.ResultsVideo-based TeleNP screenings were conducted for 67 children with developmental (i.e., attention deficit hyperactivity disorder, autism spectrum disorder) and language disorders, as well as concussion and psychiatric diagnoses. Additional comorbidities were identified in 65.6% of children. Follow-up data approximately 2 months later revealed 98.5% of children were receiving new interventions as a result of the video-based TeleNP assessment.ConclusionVideo-based TeleNP benefits the consumer as it can reduce wait times, decrease family financial burden (i.e., travel and parent time off work), expedite referrals for interventions, and provide geographically under-served populations access to providers who are linguistically and culturally responsive. For providers, this model revealed improvements with direct implications for cost-saving, thereby facilitating long-term economic sustainability within a private practice healthcare marketplace.

Changes in Health Care–Related Financial Burden for US Families With Children Associated With the Affordable Care Act

The Affordable Care Act (ACA) sought to improve access and affordability of health insurance. Although most ACA policies targeted childless adults, the extent to which these policies also impacted families with children remains unclear. To examine changes in health care-related financial burden for US families with children before and after the ACA was implemented based on income eligibility for ACA policies. Data used for this cohort study were obtained from the 2000-2017 Medical Expenditure Panel Survey, a nationally representative, population-based survey. Multivariable regression with a difference-in-differences estimator was used to examine changes in family financial burden before and after ACA implementation according to income-based ACA eligibility groups (≤138% [lowest-income], 139%-250% [low-income], 251%-400% [middle-income], and >400% [high-income] federal poverty level). The cohort included 92 165 families with 1 or more children (age ≤18 years) and 1 or more adult parents/guardians. Income-based eligibility groups during post-ACA years (calendar years 2014-2017) vs pre-ACA years (calendar years 2000-2013). Family annual out-of-pocket (OOP) health care and premium cost burden relative to income. High OOP burden was determined based on a previously validated algorithm with relative cost thresholds that vary across incomes, and extreme OOP burden was defined as costs exceeding 10% of income. Premiums exceeding 9.5% of income were classified as burdensome and premiums relative to median household income defined an unaffordability index. Compared with high-income families who experienced a lesser change post-ACA implementation (high OOP burden, 1.1% pre-ACA vs 0.9% post-ACA), the lowest-income families saw the greatest reduction in high OOP burden (35.6% pre-ACA vs 23.7% post-ACA; difference-in-differences: -11.4%; 95% CI, -13.2% to -9.5%) followed by low-income families (24.6% pre-ACA vs 17.3% post-ACA, difference-in-differences: -6.8%; 95% CI, -8.7% to -4.9%) and middle-income families (6.1% pre-ACA vs 4.6% post-ACA, difference-in-differences: -1.2%; 95% CI, -2.3% to -0.01%). Although premiums rose for all groups, premium unaffordability was the least exacerbated for the lowest-, low-, and middle-income families compared with higher-income families. The findings of this study suggest that low- and middle-income families with children who were eligible for ACA Medicaid expansions and Marketplace subsidies experienced greater reductions in health care-related financial burden after the ACA was implemented compared with families with higher incomes. However, despite ACA policies, many low- and middle-income families with children appear to continue to face considerable financial burden from premiums and OOP costs.

The Mental Health Parity and Addiction Equity Act evaluation study: Child and adolescent behavioral health service expenditures and utilization.

This study explores possible associations of the Mental Health Parity and Addiction Equity Act (MHPAEA) with child access to behavioral health (BH) services (preimplementation = 2008-2009, transition = 2010, and post = 2011-2013). The study sample included children aged 4-17 years in self-insured "carve-in" plans from large employers. In "carve-ins," BH and medical care are covered through the same insurance plan. The unit of analysis is the person-month (N = 61,823,533). This study employs an interrupted time series model allowing for intercept and slope changes for the transition and postparity periods. Outcomes included total, plan and patient out-of-pocket (OOP) expenditures, and several categories of service utilization. Generalized estimating equations were used to account for clustering. There were significant increases in total and plan expenditures postparity. To illustrate, in July 2012, mean per-member-per-month total expenditures were predicted to be $5.65 without parity but $8.72 with parity. Patient OOP costs did not change significantly. Significant overall increases were seen for utilization of most outpatient services but not intermediate or inpatient services. Our findings suggest that the introduction of MHPAEA was associated with an increase in specialty BH service access for children without a commensurate increase in financial burden for families.

Social wellbeing among women living with cancer

Women living with cancer are gradually increases in number due to the increase prevalence of breast and cervical cancer worldwide. The social impact of cancer is underappreciated compared to physical and psychological impacts. This study aimed to: 1) compare and analyze the social wellbeing (SWB) between women living with breast and cervical cancer, and 2) determine the best predictor of SWB in both groups. This cross-sectional study involved 58 and 47 women living wih breast and cervical cancer (n=105). Questionnaire of QOL-CS part III was used in data collection. Various statistical tests were used in data analysis (α&amp;lt;0.05). Sufficient SWB was mostly found in both cases. Family stress, work life, home activities, worriness, social support, personal relation, sexuality, social isolation, and financial burden were significantly different between cases (p=0.021, p=0.027, p=0.004, p=0.022, p=0.000, p=0.000, p=0.000, p=0.000, and p=0.001 respectively), resulted in significant difference in overall SWB between cases (p=0.000). Home activities were the best predictor of SWB in both cases (R2=0.680 and R2=0.840 respectively) with more influences on cervical cancer (84% of influence). SWB was better in women living with breast cancer.

Factors influencing caregiver strain among foster, kin, and adoptive parents

ABSTRACTA better understanding of how to support resource (foster, kinship, and adoptive caregivers) is needed to ensure high-quality home-based care for children who cannot reside safely in their homes. Using the Caregiver Strain Questionnaire, this study examined factors that predicted the extent to which caregivers experienced Objective Strain (the disruption of family routines and financial burden) and Subjective Strain (feelings of guilt, anxiety, and fatigue). Regression analyses suggest that resource parents who are caring for children who need mental health services experience higher levels of stress than other parents. Factors that mitigate strain include access to quality mental health services provided by child welfare and mental health professionals who are adoption-competent and trauma-informed, and the provision of adequate financial support. Findings suggest that supports from skilled service providers are critical for preventing stress and burnout in resource parents.

Application and enlightenment of rehabilitation in intensive care unit

Rehabilitation of patients with critical illness is raising worldwide attention, as it is key to promote patients’ recovery, reduce prevalence of disability, improve long-term quality of life and lighten the family financial and care burden. Rehabilitation of patients with critical illness contains basic rehabilitation (mobilization, nutrition rehabilitation, physical therapy, occupation therapy) and special rehabilitation (cardiac rehabilitation, pulmonary rehabilitation, neurological rehabilitation, psychological rehabilitation). This article summarized the application of rehabilitation in Intensive Care Unit. Rehabilitation of patients with critical illness needs a special rehabilitation team to implement. Early rehabilitation with normative standard and persistence is core to improve quality of life in patients survived from critical illness. Key words: Intensive care units; Severe rehabilitation; Application

‘There is family tension, but they understand…’: familial and sibling relationships following the diagnosis of cerebral palsy in children in Ghana

The challenges faced by parents raising children with cerebral palsy (CP) have been well explored in the literature. However, little attention has been paid to the experiences of parents raising children with CP in low-income countries, such as Ghana. Objective: Therefore, the objective of this study was to explore parents’ experiences of raising children with CP, specifically focusing on the relationships between spouses and between children with CP and their typically developing siblings. Method: Qualitative semi-structured interviews were conducted with 40 parents, who were purposively selected from the largest tertiary hospital in Ghana. Results: The results revealed that typically developing children accept their siblings with CP as their equals and even take up domestic responsibilities to lessen the burden on their parents. However, the parents reported experiencing marital and extended family conflict, financial burden and negative attitudes from spouses, resulting in family tensions. Conclusion: The implications of these findings for policy-making have also been discussed.

Effects of Tongfengtai combined with family follow-up nursing on the therapeutic efficacy and self-management ability of patients with gout

Objective To explore the effects of Tongfengtai combined with family follow-up nursing on the therapeutic efficacy and self-management ability of patients with gout. Methods A total of 84 patients with acute damp-heat accumulation gout were selected.According to the random number table method, they were divided into two groups, 42 cases of each group.The control group was given western medicine and routine nursing measures.On the basis of in the control group, the experimental group was given traditional Chinese medicine Tongfengtai combined with family follow-up nursing intervention.After 3 months of intervention, the therapeutic effect and self-management ability of the two groups were observed. Results After the intervention, the total effective rate in the experimental group was significantly higher than that in the control group, and the difference was statistically significant(P<0.01). The total score of self-management behavior, medication taking according to the doctor's advice, blood uric acid level, diet control, weight control and gout acute attack score in the experimental group were all higher than those in the control group, and the differences were statistical significance(P<0.05). Conclusions The application of Tongfengtai combined with family follow-up nursing in patients with gout is very consistent with the integration of traditional Chinese medicine and nursin and the concept of three-part treatment and seven-part nourishment-based treatment . It has effectively improved patients' self-management behavior and curative effect, delayed the progress of the disease, and reduced patients' pain and family financial burden. Key words: Tongfengtai; Family follow-up care; Gout; Self-management ability

DETERMINING FACTORS IN THE SITUATIONAL TRANSITION OF FAMILY MEMBERS WHO CARE OF ELDERLY PEOPLE WITH PARKINSON'S DISEASE

ABSTRACT Objective: to investigate the facilitator and inhibitory factors in the transition of elderly caregivers with Parkinson's disease. Method: a qualitative, exploratory and descriptive study, based on the family transition nursing theory developed with 20 elderly caregivers of elderly people with Parkinson 's disease, enrolled in the Associação Parkinson de Santa Catarina, from March to August 2015. To analyze and interpret the data, we used the thematic analysis of content proposed by Bardin, with the help of the ATLAS.ti software for data organization. Results: some factors were identified and considered as facilitators for the process of transition from the familiar to the exercise of the role of caregiver, such as: previous experiences as caregiver; spirituality and religiosity; family support network and health services. Other factors were identified as inhibiting factors for transition: emotional and physical health conditions; advanced age; personal life activities/commitments; family financial burden; and inadequate family support. It was observed that most family caregivers reported having previous experience in caring, having advanced age, and being able to care for the elderly with the disease. However, he considers his condition of emotional and physical health insufficient, resulting in overload. Lack of access to health services and family and financial support make it difficult to provide care. Conclusion: nurses should seek strategies to direct attention to facilitating factors in the family context in order to help the family to achieve well-being and healthy transition to the role of caregiver.

Identification of Family Factors That Affect Self-Management Behaviors Among Patients With Type 2 Diabetes: A Qualitative Descriptive Study in Chinese Communities

In the past 30 years, the prevalence of diabetes in China has increased from 0.67% to 11.6%. Self-management behaviors (SMBs) are significant to improve health outcomes for diabetics. However, little is known about self-management experiences of Chinese diabetic patients. The purpose of this study was to explore family factors affecting SMBs. A qualitative descriptive study was used. Purposive samples were recruited from Chinese communities. Semistructured interviews were conducted, and audio-recordings transcripts were analyzed using content analysis methods. Twenty participants were interviewed, including 8 with well-controlled HbA1c while 12 were poorly controlled. Facilitators that promote patients' SMBs were responsibility toward children and commitment to spouse; barriers that hinder patients' SMBs were family experiences about starvation, seeking harmony-eating in a big family, living in an "empty nest," and family financial burden. This study provides insight into SMBs of Chinese diabetic patients. Professionals can develop tailored interventions in a Chinese cultural context according to patients' perceptions of family responsibility, early experience, activities, and resources.

ANALISIS PROFIL USAHA EKONOMI DESA SIMPAN PINJAM (UED SP) BIDANG PERKEBUNAN DI DESA BANTAN TENGAH KECAMATAN BANTAN KABUPATEN BENGKALIS

This research aimed to know the economic effort’s profile saving and loan village (UED SP) about plantation in Bantan Tengah district of Bengkalis regency. The background of the research was UED SP program as the government effort to reduce destitute society in economic policy continuously. Meanwhile there were some obstacle in implementation of UED SP activities were not effective in the real implementation .it can be proven from the arrear every month and abuse fund from UED SP members. The objectives of the research were to know the profile comparison of UED SP from every effort that conducted by the profiler. This research was implemented in Bantan Tengah and used qualitative descriptive method to collect the information from UED SP Program. The result showed that there is significant effect of UED SP program toward receiver’s income. It can be concluded that there was a significant effect increasing of UED SP profiler’s income. The significant factors that influence the income of profiler UED SP such as education level, effort experience, family financial burden. In addition the highest participation of the society in every steps in program is the most important thing to determine the successfully of the program to increase social welfare of society in Bantan village Bengkalis regency.

Recurrent lower respiratory illnesses among young children in rural Kyrgyzstan: overuse of antibiotics and possible under-diagnosis of asthma. A qualitative FRESH AIR study

Lower respiratory tract illnesses (LRT-illnesses) in children under 5 years (U5s) are a leading cause of morbidity, hospitalisations and mortality worldwide, particularly in low-income countries. It is pertinent to understand possible inconsistent management. This study explored perceptions and practices among caregivers and health professionals on recurrent LRT-illnesses in U5s. Semi-structured interviews with 13 caregivers to U5s with recurrent LRT-illnesses and with 22 primary care health professional interviews in two rural provinces in Kyrgyzstan were triangulated. Data were thematically analysed. The majority (8/13) of caregivers described their young children as having recurrent coughing, noisy breathing and respiratory distress of whom several had responded positively to acute salbutamol and/or had been repeatedly hospitalised for LRT-illness. Family stress and financial burdens were significant. The health professionals classified young children with recurrent LRT-illnesses primarily with pneumonia and/or a multitude of bronchitis diagnoses. Broad-spectrum antibiotics and supportive medicine were used repeatedly, prescribed by health professionals or purchased un-prescribed by the caregivers at the pharmacy. The health professionals had never applied the asthma diagnosis to U5s nor had they prescribed inhaled steroids, and none of the interviewed caregivers’ U5s were diagnosed with asthma. Health professionals and caregivers shared a common concern for the children’s recurrent respiratory illnesses developing into a severe chronic pulmonary condition, including asthma. In conclusion, the study identified an inconsistent management of LRT-illnesses in U5s, with exorbitant use of antibiotics and an apparently systemic under-diagnosis of asthma/wheeze. When the diagnosis asthma is not used, the illness is not considered as a long-term condition, requiring preventer/controller medication.

Benefits of Medical Home Care Reaching Beyond Chronically Ill Teens: Exploring Parent Health-Related Quality of Life

BackgroundCaring for teens with special health care needs places physical and mental health burdens on parents, which can be exacerbated by the stresses of transitions to independence. Medical homes can improve teen transitions to greater self-management and reduce health care–related time and financial burdens for families. We examined the association between parent-reported teen medical home status and caregiver health-related quality of life (HRQOL). MethodsThe study sample included parents or caregivers of teens with special health care needs aged 15 to 18 recruited from a pediatric Medicaid accountable care organization who participated in a survey (response rate, 40.5%). The primary outcome was parent HRQOL scores (0–100 points) measured using the Pediatric Quality of Life Inventory Family Impact Module. Medical home status was based on parent report of teen's health care meeting medical home criteria. Linear regression models were used to estimate HRQOL scores, adjusted for demographic characteristics, health literacy, and teen functional limitation. ResultsAmong 488 parents, 27% reported their teen received care consistent with a medical home. Adjusted parent HRQOL scores were significantly higher among those whose teens had a medical home (74.40; 95% confidence interval, 71.31–77.48), relative to those whose teens did not (65.78; 95% confidence interval, 63.92–67.65). Medical home subscale analyses showed HRQOL scores had significant positive associations with family-centered care and coordinated care, but not other subscales. ConclusionsTeen medical home status was positively associated with caregiver HRQOL, suggesting that the medical home may benefit overall caregiver well-being. In particular, receiving care that was family centered and coordinated appeared to be the most beneficial.

Carga financiera del cuidado del enfermo crónico en un grupo de familias en Guatemala

Como objetivo del trabajo se planteó describir la carga financiera del cuidado del enfermo crónico en un grupo de familias en Guatemala, para ello se realizó un estudio descriptivo, de corte transversal que se desarrolló en 2014 como parte de un estudio multicéntrico. Se emplearon para la recolección de datos dos encuestas: para caracterizar al grupo familiar la encuesta “GCPC-UN- D y para conocer el consumo real efectivo de las familias la encuesta “Costo financiero del cuidado de la Enfermedad crónica” de Montoya et al. Para analizar la carga financiera se empleó la Metodología CARACOLA. Los resultados revelaron que los costos propios de salud, seguidos por los de transporte, vivienda, comunicaciones y alimentos son los que en conjunto y en ese orden producen carga financiera familiar del cuidado del enfermo crónico. Se concluye que el consumo real efectivo de un grupo de familias en Guatemala asociado con el cuidado de un enfermo crónico, genera carga financiera elevada produciendo un impacto importante en la estabilidad familiar y dificulta aún más la experiencia de salud. Es clara la necesidad de incluir en las políticas públicas la forma de considerar y mitigar los costos del cuidado

Family rituals, financial burden, and mothers' adjustment in pediatric cancer.

The financial burden of childhood cancer may contribute to the distress that parents experience during and after treatment. Inconsistent relationships between financial burden and parental psychological distress highlight the need to identify psychosocial factors that may moderate this relationship. In this study, we aimed to determine if family ritual meaning moderates the relationship between financial burden and anxiety and depression symptoms among mothers of children with cancer. Portuguese mothers of children with cancer on-treatment and off-treatment (N = 244) completed measures of financial burden, anxiety and depression symptoms, and family ritual meaning. Moderating effects were tested using hierarchical multiple regression analyses. Family ritual meaning buffered the effect of financial burden on anxiety, but not on depression symptoms. The relationship between financial burden and anxiety symptoms was not significant when mothers endorsed higher levels of family ritual meaning. Although preliminary, the current findings suggest that high levels of perceived family ritual meaning may constitute a protective factor against the effect of financial burden on mothers' anxiety symptoms. Promoting family ritual meaning might be an effective approach to reducing anxiety symptoms of mothers of children with cancer in the context of financial burden. (PsycINFO Database Record

A cross-sectional study of parental awareness of and reasons for lack of health insurance among minority children, and the impact on health, access to care, and unmet needs.

BackgroundMinority children have the highest US uninsurance rates; Latino and African-American children account for 53 % of uninsured American children, despite comprising only 48 % of the total US child population. The study aim was to examine parental awareness of and the reasons for lacking health insurance in Medicaid/CHIP-eligible minority children, and the impact of the children’s uninsurance on health, access to care, unmet needs, and family financial burden.MethodsFor this cross-sectional study, a consecutive series of uninsured, Medicaid/CHIP-eligible Latino and African-American children was recruited at 97 urban Texas community sites, including supermarkets, health fairs, and schools. Measures/outcomes were assessed using validated instruments, and included sociodemographic characteristics, uninsurance duration, reasons for the child being uninsured, health status, special healthcare needs, access to medical and dental care, unmet needs, use of health services, quality of care, satisfaction with care, out-of-pocket costs of care, and financial burden.ResultsThe mean time uninsured for the 267 participants was 14 months; 5 % had never been insured. The most common reason for insurance loss was expired and never reapplied (30 %), and for never being insured, high insurance costs. Only 49 % of parents were aware that their uninsured child was Medicaid/CHIP eligible. Thirty-eight percent of children had suboptimal health, and 2/3 had special healthcare needs, but 64 % have no primary-care provider; 83 % of parents worry about their child’s health more than others. Unmet healthcare needs include: healthcare, 73 %; mental healthcare, 70 %; mobility aids/devices, 67 %; dental, 61 %; specialty care, 57 %; and vision, 46 %. Due to the child’s health, 35 % of parents had financial problems, 23 % cut work hours, and 10 % ceased work. Higher proportions of Latinos lack primary-care providers, and higher proportions of African-Americans experience family financial burden.ConclusionsHalf of parents of uninsured minority children are unaware that their children are Medicaid/CHIP-eligible. These uninsured children have suboptimal health, impaired access to care, and major unmet needs. The child’s health causes considerable family financial burden, and one in 10 parents ceased work. The study findings indicate urgent needs for better parental education about Medicaid/CHIP, and for improved Medicaid/CHIP outreach and enrollment.