Abstract
Objective The purpose of this study was to examine the prevalence of unmet mental health needs in children identified by parents as having long-term emotional and behavioral problems, to identify the characteristics of these children, and to evaluate the influence of health insurance status and type on the odds of reporting unmet mental health needs. Methods We used the National Survey of Children with Special Health Care Needs (NSCSHCN) to estimate the prevalence of unmet mental health needs among children with long-term emotional/behavioral conditions. Using logistic regression models, we also assessed the independent impact of insurance status and type on unmet needs. Results Analyses indicated that of the nearly 67% of children who needed mental health care or counseling in the previous 12 months, 20% did not receive it. Moreover, parents of uninsured children were more likely to report unmet mental health needs than insured children. Parents of children covered by public health insurance programs (Medicaid, Children Health Insurance Program-CHIP, Title V, Military, Native American) were less likely to report unmet mental health needs than those with children covered by private health insurance plans. Conclusion Results from this study suggest a need for expansion of health insurance coverage to children especially those with long-term mental health conditions. It also suggests a need for parity between mental and physical health benefits in private health insurance.
Similar content being viewed by others
Abbreviations
- CSHCN:
-
Children with special health care needs
- CHIP:
-
Children’s Health Insurance Program
- EDB:
-
Emotional, development, or behavioral
- FPL:
-
Federal poverty level
- NSCSHCN:
-
National Survey of Children with Special Health Care Needs
References
NAMI. (1999). Families on the brink: the impact of ignoring children with serious mental illness.
U.S. Department of Health and Human Services, Health Resources and Service Administration, Maternal and Child Health Journal. (2004). The National Survey of Children with Special Health Care Needs Chartbook 2001 (p. 111).
McPherson, M., Arango, P., Fox, H., Lauver, C., McManus, M., Newacheck, P., et al. (1998). A new definition of children with special health care needs. Pediatrics, 102(1), 137–140. doi:10.1542/peds.102.1.137.
Van Dyck P., Kogan M., McPherson M., Weissman G., Newacheck P. (2004). Prevalence and characteristics of children with special health care needs. Archives of Pediatric and Adolescent Medicine, 158, 884–890. doi:10.1001/archpedi.158.9.884.
Briggs-Gowan, M., Horwitz, S. C., Schwab-Stone, M., Leventhal, J., & Leaf, P. J. (2000). Mental health in pediatric settings: Distribution of disorders and factors related to service use. Journal of the American Academy of Child and Adolescent Psychiatry, 39(7), 841–849. doi:10.1097/00004583-200007000-00012.
USDHHS. (2000). Mental Health: A report of the Surgeon General.
Leaf, P. J., Alegria, M., Cohen, P., Goodman, S. H., Horwitz, S., Hoven, C., et al. (1996). Mental health service use in the community and schools: Results from the four-community MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35(7), 889–899. doi:10.1097/00004583-199607000-00014.
Shaffer, D., Fisher, P., Dulcan, M., Davies, M., Piacentini, J., Schwab-Stone, M., et al. (2000). The NIMH Diagnostic Interview Schedule for children version 2.3: Description, acceptability, prevalence rates, and performance in the MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35(7), 865–877.
Wood, D., Hayward, R., Corey, C., Freeman, H. E., & Shapiro, M. (1990). Access to medical care for children and adolescents in the United States. Pediatrics, 86, 666–673.
Holl, J., Szilagyi, P. G., Rodewalk, L., Bryd, R., & Weitzman, M. (1995). Profile of uninsured children in the United States. Archives of Pediatric and Adolescent Medicine, 149, 398–406.
Currie, J., & Gruber, J. (1995). Health Insurance eligibility, utilization of medical care, and child health. Quarterly Journal of Economics, 274, 1429–1435.
Aday, L., Lee, E., Spears, B., Chung, C., Youssef, A., & Bloom, B. (1993). Health insurance and utilization of medical care for children with special health care needs. Medical Care, 31, 1013–1026. doi:10.1097/00005650-199311000-00004.
Newacheck, P., Stoddard, J., Hughes, D., & Pearl, M. (1998). Health insurance and access to primary care for children. New England Journal of Medicine, 338(8), 513–519. doi:10.1056/NEJM199802193380806.
Porterfield, S., & McBride, T. (2007). The effect of poverty and caregiver education on preceived need and access to health services among children with special health care needs. American Journal of Public Health, 97(2), 323–329. doi:10.2105/AJPH.2004.055921.
Newacheck, P., Hughes, D., Hung, Y.-Y, Wong, S., & Stoddard, J. (2000). The unmet health needs of America’s children. Pediatrics, 105(4), 989–997. doi:10.1542/peds.105.4.760.
Newacheck, P., McManus, M., Fox, H., Hung, Y.-Y, & Halfon, N. (2000). Access to health care for children with special health care needs. Pediatrics, 105(4), 760–766. doi:10.1542/peds.105.4.760.
Yu, H., Dick A., & Szilagyi, P. G. (2006–2007). Role of SCHIP in serving children with special health care needs. Health Care Financing Review, 28(2), 53–64.
Newacheck, P., Pearl, M., Hughes, D., & Halfon, N. (1998). The role of medicaid in ensuring children’s access to care. The Journal of the American Medical Association, 280(20), 1789–1793. doi:10.1001/jama.280.20.1789.
Ganz, M. L., Shalini, A., & Tendulkar, A. (2006). Mental health care services for children with special health care needs and their family members: prevalence and correlates of unmet needs. Pediatrics, 117(6), 2138–2149. doi:10.1542/peds.2005-1531.
Feinberg, E., Swartz, A., Zaslavsky, A., Gardner, J., & Walker, D. K. (2002). Family income and the impact of a children’s health insurance program on reported need for health services and unmet health need. Pediatrics, 109(2), 29–39. doi:10.1542/peds.109.2.e29.
Fox, M. H., Moore, J., Davis, R., & Heintzelman, R. (2003). Changes in reported health status and unmet need for children enrolling in the Kansas Children’s Health Insurance Program. American Journal of Public Health, 93(4), 579–589.
Szilagyi, P. G., Shenkman, E., Brach, C., LaClair, B. J., Swigonski, N., Dick, A., et al. (2003). Children with special health needs enrolled in the state children’s health insurance program (SCHIP): Patient characteristics and health care needs. Pediatrics, 112(6), 508–520.
Lave, J. R., Keane, C. R., Lin, C. J., Ricci, E. M., Amersbach, G., & LaVallee, C. P. (1998). The Impact of lack of health insurance on children. Journal of health and Social Policy, 10(2), 57–73. doi:10.1300/J045v10n02_05.
Kenney, G., & Yee, J. (2007). SCHIP at a crossroads: experiences to date and challenges ahead. Health Affairs, 26(2), 356–369. doi:10.1377/hlthaff.26.2.356.
Szilagyi, P. G., Shone, L., Klein, J., Bajorska, A., & Dick, A. (2007). Improved health care among children with special health needs after enrollment into the state children’s health insurance program. Ambulatory Pediatrics, 7(1), 10–17. doi:10.1016/j.ambp.2006.09.006.
Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among U.S. children: variation by ethnicity and insurance status. American Journal of Psychiatry, 159(9), 1548–1555. doi:10.1176/appi.ajp.159.9.1548.
Frank, R., Koyanagi, C., & McGuire, T. (1997). The politics and economics of mental health parity laws. Health Affairs, 16(4), 108–119. doi:10.1377/hlthaff.16.4.108.
Burnam, M. A., & Escarce, J. (1999). Equity in managed care for mental disorders. Health Affairs, 18(5), 22–31. doi:10.1377/hlthaff.18.5.22.
Buck, J., Teich, J., Umland, B., & Stein, M. (1999). Behavioral health benefits in employer-sponsored health plans, 1997. Health Affairs, 18(2), 67–78. doi:10.1377/hlthaff.18.2.67.
Frank, R., & McGuire, T. (1994). Health reform and financing of mental health services: Distributional consequences. In R. Manderscheid & M. Sonnenschein (Eds.), Mental Health, United States, 1994. Washington, DC: U.S. Government Printing Office.
Andersen, R. (1968). Behavioral model of families’ use of health services. Chicago: University of Chicago.
Andersen, R., & Newman, J. (1973). Societal and individual determinants of medical care utilization in the United States. The Milbank Memorial Fund Quarterly, 51, 95–124. doi:10.2307/3349613.
Andersen, R. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10. doi:10.2307/2137284.
Bethell, C. D., Read, D., Stein, R., Blumberg, S., Wells, N., & Newacheck, P. (2002). Identifying children with special health care needs: Development and evaluation of a short screening instrument. Ambulatory Pediatrics, 2(1), 38–48. doi:10.1367/1539-4409(2002)002<0038:ICWSHC>2.0.CO;2.
Blumberg, S., Olson, L., Frankel, M., Osborn, L., Becker, C., Srinath, K. P., Giambo, P. (2003). Design and operation of the National Survey of Children with Special Health Care Needs, 2001. National Center for Health Statistics. Vital Health Statistics, Series 1(41), 1–36.
Van Dyck, P., Kogan, M., Heppel, D., Blumberg, S., Cynamon, M., & Newacheck, P. (2004). The national survey of children’s health: A new data resource. Maternal and Child Health Journal, 8(3), 183–188. doi:10.1023/B:MACI.0000037693.09847.f6.
Jokovic, A., Locker, D., & Guyatt, G. (2003). How well do parents know their children? Implications for proxy reporting of child health-related quality of life. Quality of Life and Research, 13, 1297–1307. doi:10.1023/B:QURE.0000037480.65972.eb.
von Essen, L. (2004). Proxy ratings of patient quality of life. Acta Oncologica, 43(3), 229–234. doi:10.1080/02841860410029357.
Mayer, M., Skinner, A., & Slifkin, R. (2004). Unmet need for routine and specialty care: Data from the National Survey Of Children With Special Health Care Needs. Pediatrics, 113(2), 109–115. doi:10.1542/peds.113.2.e109.
Strickland, B., McPherson, M., Weissman, G., van Dyck, P., Huang, Z., & Newacheck, P. (2004). Access to the medical home: Results of the national survey of children with special health care needs. Pediatrics, 113(5), 1485–1492.
Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/Adolescent behavioural and emotional problems: Implications of cross-informant correlations for situational specificity. Psychological Bulletin, 101(2), 213–232. doi:10.1037/0033-2909.101.2.213.
Blumberg, S., Osborn, L., Luke, J., Olson, L., & Frankel, M. (2004). Estimating the prevalence of uninsured children: An evaluation of data from the National Survey Of Children With Special Health Care Needs. Vital and Health Statistics, 2(136), 1–46.
Wells, K. B., Kataoka, S. H., & Asarnow, J. R. (2001). Affective disorders in children and adolescents: Addressing unmet need in primary care settings. Society of Biological Psychiatry, 49, 1111–1120. doi:10.1016/S0006-3223(01)01113-1.
Mechanic, D., & McAlpine, D. (1999). Mission unfulfilled: Potholes on the road to mental health parity. Health Affairs, 18(5), 7–21. doi:10.1377/hlthaff.18.5.7.
Sturm, R., & McCulloch, J. (1998). Mental health and substance abuse benefits in carve-out plans and the mental health parity act of 1996. Journal of Health Care Finance, 24(3), 82–92.
Bazelon. (2004). Mental health hits and misses in 108th Congress. Retrieved from http://www.bazelon.org/takeaction/archive/2004/12-04update.htm. on 11 Nov 2005.
Smith, V., Rousseau, D. (2005). SCHIP enrollment in the 50 States: Kaiser Family Foundation.
Haley, J., Kenney, G. (2001). Why aren’t more uninsured children enrolled in Medicaid or SCHIP? Urban Institute.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
DeRigne, L., Porterfield, S. & Metz, S. The Influence of Health Insurance on Parent’s Reports of Children’s Unmet Mental Health Needs. Matern Child Health J 13, 176–186 (2009). https://doi.org/10.1007/s10995-008-0346-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-008-0346-0