文章基本信息

标题：The Effect of Poverty and Caregiver Education on Perceived Need and Access to Health Services Among Children With Special Health Care Needs
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作者：Shirley L. Porterfield ; Timothy D. McBride
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2007
卷号：97
期号：2
页码：323-329
DOI：10.2105/AJPH.2004.055921
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined the association between several variables and the use of specialist physician services, developmental therapies, and prescription medications among children with special health care needs (N=38866). Methods. We used a bivariate probit model to estimate whether a given child needed specialized services and whether that child accessed those services; we controlled for activity limitations and severity of special needs. Variables included family income, mother’s (or other caregiver’s) educational level, health insurance coverage, and perceived need for specialized services. We used data from the 2001 National Survey of Children with Special Health Care Needs. Results. Lower-income and less-educated parents were less likely than higher-income and more-educated parents to say their special needs children needed specialized health services. The probability of accessing specialized health services—when needed—increased with both higher family income and insurance coverage. Conclusions. Children with special health care needs have less access to health services because their parents do not recognize the need for those services. An intervention in the form of information at the family level may be an appropriate policy response. Nearly 1 in 5 families in the United States have a child with special health care needs. 1 Children with special health care needs, both physical and mental, are significantly more likely to live with poor families compared with children in general. 2 ^– 5 Although poverty is a risk factor for poor health among children, low parental education adds to this risk. 6 ^– 10 Lack of education is highly associated with low family income, and many families may not realize that children who “take their time” to gain particular skills have a disability or a delay that may be helped by a medical or therapeutic intervention. A survey of adults who accompanied special needs children during appointments with specialist physicians found that only half these caretakers (82.5% were parents) were able to provide even a lay description of their child’s diagnosis. 11 Information, including available intervention strategies, was the greatest expressed need in a recent survey of parents of children with disabilities. 12 This suggests that support services should be tailored to meet the needs of intended recipients—both children and their caregivers. 13 Although children with special health care needs are as likely as other children to have health insurance coverage, 14 ^, 15 previous research has found lower use of specialty care among children whose parents were low income or less educated. 8 ^– 10 We hypothesized that information about special needs plays a key role in seeking specialty care—i.e., if parents do not think that their child needs a particular health care service, they will not seek access to that service. Therefore, even though a child with special health care needs may have insurance coverage for specialty care, service use will only occur if the parent seeks treatment. We examined the association between several variables—family poverty, caregiver education level, health insurance coverage, perceived need for specialized health care—and the use of 3 types of specialty health care services—specialist physicians, developmental therapies, and prescription drugs—among children with special health care needs. We also examined caregiver-reported reasons for why some children’s service requests were not met. The perceived need for specialty health care services was assumed to be based on information provided to the parents. Information has typically been characterized as an asymmetry problem in health services research—i.e., the physician has more medical knowledge than the patient does. 16 We hypothesized that asymmetry also occurs when physicians (and possibly insurers) lack information about the efficacy of possible interventions 7 and when physicians perceive immigrant, minority, less-educated, and lower-income patients to be less able to act on medical information. 17 ^– 19 In either case, physicians may not pass critical information on to the parents of their patients. Furthermore, higher-income and more-educated parents may have access to additional sources of information that less-educated and lower-income families generally do not have access to. 20 As a result, poverty and lack of education may reduce a parent’s access to information about interventions for their child. Poverty also may contribute to a lack of health insurance, or underinsurance, and thus reduce access to needed services. We therefore hypothesized that use of health services would be influenced by both perceived need (information) and access to care. We predicted that higher-income and more-educated parents would be more likely to report that their special needs child needed a specialized health service and that this child would also be more likely to access this service compared with a similar child with lower-income and less-educated parents. We included additional variables in our study: (1) race/ethnicity, because discrimination may affect perceived need for specialized health care services; (2) number of adults in the household, because it may influence income status, and it may have some influence on levels of information; (3) native language, because parents who speak English as a second language may have difficulty gaining information and using the health care system; (4) child’s age, because health care needs change as children age; and (5) health insurance, because it affects access to health services.