Table 2.
Adjusted Outcomes for Privately Insured Children with Special Health Care Needs (CSHCN) by Need for Mental Health Care, 2005–2006
| Comparing CSHCN (no needed specialty care) with and without mental health care need OR (95% CI)a | Comparing CSHCN (needed specialty care) with and without mental health care need OR (95% CI)b | Comparing CSHCN with ADHDc with mental health care need to CSHCN without mental health care need OR (95% CI)a | Comparing CSHCN with emotional problemsd with mental health care need to CSHCN without mental health care need OR (95% CI)a | Comparing CSHCN with autisme with mental health care need to CSHCN without mental health care need OR (95% CI)a | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| N | 15746 | 9856 | 13910 | 14079 | 11857 | |||||
| Financial outcomes (%) | ||||||||||
| Out-of-pocket costs > $500 | 1.88 (1.63–2.15) | *** | 1.31 (1.12–1.52) | *** | 1.80 (1.53–2.11) | *** | 2.13 (1.80–2.53) | *** | 2.36 (1.52–3.65) | *** |
| Out-of-pocket costs > $1000 | 1.94 (1.69–2.23) | *** | 1.32 (1.13–1.54) | *** | 1.78 (1.51–2.11) | *** | 2.09 (1.77–2.46) | *** | 2.20 (1.45–3.33) | *** |
| Out-of-pocket costs > $5000 | 1.69 (1.26–2.25) | *** | 1.30 (.95–1.78) | 1.34 (.96–1.88) | * | 1.86 (1.34–2.58) | *** | 1.64 (.93–2.87) | * | |
| Child’s health care has caused financial problems | 1.74 (1.48–2.05) | *** | 1.35 (1.13–1.61) | *** | 1.60 (1.31–1.96) | *** | 2.18 (1.80–2.63) | *** | 2.31 (1.47–3.62) | |
| Need additional income to care for child | 1.57 (1.32–1.87) | *** | 1.22 (1.01–1.47) | ** | 1.42 (1.15–1.75) | *** | 1.89 (1.55–2.31) | *** | 2.63 (1.66–4.17) | *** |
| Health plan experience outcomes (%) | ||||||||||
| Health insurance meets child’s needs (1=never, sometimes) | 1.65 (1.38–1.97) | *** | 1.50 (1.22–1.83) | *** | 1.63 (1.31–2.04) | *** | 1.75 (1.42–2.16) | *** | 3.20 (1.91–5.34) | *** |
| Costs not covered by insurance are reasonable (1=never, sometimes) | 1.39 (1.21–1.59) | *** | 1.30 (1.12–1.51) | *** | 1.45 (1.23–1.72) | *** | 1.49 (1.26–1.75) | *** | 2.23 (1.49–3.33) | *** |
| Insurance allows child to see provider that child needs (1=never, sometimes) | 2.16 (1.77–2.63) | *** | 2.12 (1.70–2.65) | *** | 2.22 (1.74–2.84) | *** | 2.24 (1.76–2.85) | *** | 3.20 (1.77–5.80) | *** |
| Labor market and time outcomes (%) | ||||||||||
| Spent >10 hours providing care | .90 (.67–1.21) | .70 (.51–.95) | ** | .830 (.58–1.19) | .87 (.62–1.22) | 1.26 (.75–2.09) | ||||
| Spent >10 hours arranging care | 1.23 (.86–1.77) | 1.33 (.89–2.00) | 1.29 (.85–1.95) | 1.27 (.83–1.93) | 1.85 (.95–3.60) | * | ||||
| Stopped work | 1.51 (1.20–1.91) | *** | 1.16 (.91–1.48) | 1.40 (1.05–1.86) | ** | 1.62 (1.24–2.13) | *** | 2.10 (1.41–3.14) | *** | |
| Stopped work or cut work hours | 1.68 (1.42–1.99) | *** | 1.290 (1.08–1.54) | *** | 1.69 (1.38–2.06) | *** | 1.74 (1.44–2.12) | *** | 2.39 (1.61–3.54) | *** |
| Parent care experience outcomes (%) | ||||||||||
| Satisfaction with services child receives (1=Somewhat/very dissatisfied) | 1.59 (1.29–1.97) | *** | 1.54 (1.23–1.93) | *** | 1.74 (1.36–2.23) | *** | 1.64 1.27–2.10) | *** | 1.73 (1.07–2.81) | ** |
| Doctors spend enough time with you (1= never/sometimes) | .97 (.81 – 1.15) | 1.21 (1.01–1.45) | ** | .98 (.80–1.20) | 1.025 (.83–1.26) | 1.01 (.67–1.50) | ||||
| Doctors listen carefully to you (1= never/sometimes) | 1.22 (.99–1.50) | * | 1.41 (1.11–1.78) | *** | 1.24 (.97–1.58) | * | 1.31 (1.03–1.68) | ** | 1.36 (.84–2.22) | |
| Doctor sensitive to values and customs (1= never/sometimes) | 1.20 (.96–1.49) | 1.31 (1.02–1.68) | ** | 1.36 (1.04–1.77) | ** | 1.39 (1.06–1.82) | ** | 1.26 (.76–2.10) | ||
| Received specific information you needed from doctors (1= never/sometimes) | 1.22 (1.02–1.46) | ** | 1.37 (1.13–1.67) | *** | 1.28 (1.07–1.58) | ** | 1.33 (1.08–1.65) | *** | 1.36 (.90–2.05) | |
| Doctors help you feel like a partner in your child’s care (1= never/sometimes) | 1.36 (1.10–1.66) | *** | 1.55 (1.26–1.92) | *** | 1.34 (1.06–1.71) | ** | 1.50 (1.16–1.93) | *** | 1.24 (.73–2.11) |
Notes: Sample includes children age 6–17 with private insurance coverage. Estimates are weighted to reflect complex sampling scheme. In all models we control for the severity of child’s condition (minor, moderate, severe); how severely the condition has affected the child’s ability to do things (a great deal; some; very little); number of adults in the household; family income (nine categories, plus one additional category for households where income is missing); mother’s education; race and ethnicity; number of children in the household; child’s age category (age 6–9 years; age 10–12 years; age 13–17 years); child’s gender; and whether the interview was conducted in a language other than English. To control for state level factors that may influence our outcome measures, we also include state dummy variables.
Comparison group comprised of CSHCN with no mental health care need.
Comparison group comprised of CSHCN with no mental health care need but reporting some need for specialty care.
ADHD includes attention deficit disorder or attention deficit hyperactive disorder.
Emotional problems include depression, anxiety, an eating disorder, or other emotional problems.
Autism includes both autism and autism spectrum disorder.