Even Before Recession, 14 Million Kids 'Underinsured'
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Even prior to the onset of the economic recession in 2008, nearly one in four American parents with health insurance reported that their coverage was so inadequate they were unable to access the medical care their children needed.
Parents of kids with health problems or special needs were more likely than others to say their insurance coverage did not meet their needs, the analysis of 2007 survey data showed.
And the problem of "underinsurance" seems to be worse for children covered by private insurance than those with government-funded coverage, the study found.
About a quarter (24.2 percent) of children with private health insurance had problems getting the care they needed, compared to 14.7 percent of children with public health insurance, such as Medicaid or the State Children's Health Insurance Program (SCHIP).
"Almost one-fourth of kids with continuous insurance were inadequately covered or underinsured, which is coverage that doesn't provide adequate benefits or provides poor coverage of costs from the parents' perspective," said lead study author Michael Kogan, director of the Office of Epidemiology, Policy and Evaluation at the Health Resources and Services Administration.
The study is published in the Aug. 26 issue of the New England Journal of Medicine.
Researchers analyzed data on nearly 92,000 children who parents took part in the 2007 National Survey of Children's Health.
An estimated 11 million U.S. children were uninsured for some or all of 2007, including 3.4 million kids who had no coverage and 7.6 million who were covered part of the year, while 14.1 million had continuous coverage but were "underinsured."
Even if they had continuous insurance coverage, adolescents, Hispanics, children in fair or poor health and children with special needs were more likely to have trouble accessing the care they needed, according to the study.
Parents were asked whether their child's health insurance offered benefits and covered services the child needed; whether the insurance allowed the child to see needed health care providers; and if the costs for deductibles, co-pays and other services not covered were reasonable.
Parents of kids with private insurance were three times more likely to report that the out-of-pocket costs for services not covered were "unreasonable," compared to people with public insurance.
For many parents, that resulted in delaying or forgoing care for their children, according to the study. Children whose parents reported they were "underinsured" were more than 3 times more likely than children with adequate coverage to delay or go without care.
Uninsured kids were more than four times more likely to have delayed or skipped medical care than kids with adequate insurance, although the difference was not statistically significant as compared to kids who were underinsured, Kogan said.
"We found that kids who are underinsured are having some of the same problems with health care access and quality as kids who are uninsured," Kogan said.
While asking parents about their perceived "reasonableness" of costs is not an objective measure of affordability, the study does highlight serious problems of accessing health care for America's children, said Dr. James Perrin, a professor of pediatrics at Harvard Medical School.
"What these researchers have demonstrated is that underinsurance is bad, almost as bad as being uninsured," Perrin said. "What we do know is children are not getting a lot of the services they should be getting."
Recent health reform legislation may help, but not solve, the problem, Perrin said. Although more children will have some sort of insurance, issues with the affordability of co-pays and deductibles, as well as limitations on benefits, will likely continue, he said.
"We know from other articles there is a tremendous increase in rates of chronic illness and disability among American children and young adults," Perrin said.
SOURCES: Michael Kogan, Ph.D., director, Office of Epidemiology, Policy and Evaluation, Health Resources and Services Administration, Rockville, Md; James Perrin, M.D., professor of pediatrics, Harvard Medical School and director, general pediatrics, Massachusetts General Hospital for Children, Boston, Mass.; New England Journal of Medicine, Aug. 26, 2010.
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