Adequacy of Health Insurance
Parents whose children were currently insured were asked three questions regarding the services and costs associated with their child's health insurance: whether the out-of-pocket costs they incurred were reasonable; whether their children's insurance offered benefits or covered services that met their children's needs; and whether their children were able to see the providers they needed. Children were considered to have adequate health insurance coverage if their parent answered “usually” or “always” to each of the three questions. Among CSHCN, 29.4 percent had inadequate coverage, compared to 22.1 percent of children without special health care needs. This difference was persistent even after adjustment for other socio-demographic differences between CSHCN and non-CSHCN.
Inadequate insurance is a far more prevalent problem than gaps in insurance or uninsurance among CSHCN: 29.4 percent had inadequate insurance, whereas 12.3 percent had gaps in insurance or no insurance. On the state level, the proportion of CSHCN with inadequate insurance ranged from 19.7 percent to 37.6 percent.
The percentage of insured CSHCN with inadequate insurance did not vary substantially by household income, but the parents of children with private insurance were considerably more likely to report that their insurance was inadequate (33.7 percent) than parents of children with public insurance (22.4 percent). This discrepancy also exists, to a lesser extent, among non-CSHCN. Among insured CSHCN, approximately 28 percent in each racial and ethnic group were reported to have inadequate insurance, with the exception of Spanish-speaking Hispanic children, of whom 41.3 percent had inadequate coverage (data not shown). This discrepancy was not seen among children without special health care needs.