The Effect of Having a Medical Home and Reported Family Financial Burden Among Children with Special Health Care Needs — Kansas, 2009-2010

BACKGROUND:  One in 5 households in the United States include ≥1 children with special healthcare needs (CSHCN); 21% of CSHCN live in families who reported financial burden (FB) meeting the child’s healthcare needs. Prior studies demonstrated reduced FB association with receiving care within a MH. The relationship between these factors among CSHCN in Kansas has not been explored; therefore, we assessed the association between having a MH and reported FB.

METHODS:  Kansas data (n = 787 CSHCN; parent-reported telephone survey) from the 2009–2010 National Survey of CSHCN were analyzed. Factors associated with reported FB (dichotomous variable Yes/No) included: healthcare through a MH (19-item composite measure) and covariates [e.g. child‘s age, sex, functional limitations, family structure, household education level, federal poverty level (FPL), insurance type, and access to healthcare] were assessed using weighted logistic regression.

RESULTS: Overall, 49.4% CSHCN had received healthcare through a MH; 26.3% CSHCN lived in families that reported FB.  Lack of a MH was associated with increased FB (adjusted odds ratio [aOR]: 1.84; 95% confidence interval [CI]: 1.08–3.17). Higher FB was reported among CSHCN living in families ≤200% FPL versus >400% FPL (aOR: 2.64: 95% CI: 1.21–5.75) and those having barriers accessing healthcare (aOR: 2.82: 95% CI: 1.64–4.84). CSHCN with no versus ≥3 functional difficulties (aOR: 0.06: 95% CI: 0.02–0.21), daily activities unaffected versus moderately/consistently affected (aOR: 0.49: 95% CI: 0.27–0.91), and with either public or private insurance versus uninsured (aOR: 0.28: 95% CI: 0.10–0.76) lived in families reporting less FB.

CONCLUSIONS: MH absence was associated with increased family FB among Kansas CSHCN. Our findings provide information to policymakers about provision of healthcare via MH.