Tuesday, April 16, 2024

Assessing the Issue of Underinsurance Among Children with Special Healthcare Requirements

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A recent study by the JAMA Network has brought to light the pressing issue of underinsurance among children with special health care needs (CSHCN) in the United States. The study aimed to evaluate the prevalence of underinsurance in this demographic, considering the complexity of medical conditions and household income levels. Despite a high number of insured children, there has been an alarming increase in pediatric underinsurance.

The study, conducted from 2016 to 2021, included a sample of 218,621 children aged 0 to 17 years who were not institutionalized.

The key findings of the research are as follows:

  1. High Prevalence of Underinsurance: The rates of underinsurance were notably high among children with complex physical conditions and limitations, as well as those with mental or behavioral conditions with limitations.
  2. Income Disparities: Underinsurance was most prevalent in families with incomes ranging from 200% to 399% of the federal poverty level. Middle-income households faced the greatest risk of underinsurance.
  3. Link with Medical Complexity: The likelihood of being underinsured increases alongside the complexity of a child’s healthcare needs. This was particularly true for children with functional limitations, complex physical conditions, and mental or behavioral conditions.
  4. Challenges for Middle-Income Families: Middle-income families, who often don’t qualify for public health insurance, struggle significantly with healthcare costs, highlighting the gap in the healthcare insurance system.
  5. Impact of Insurance Type: Children with private insurance, especially in middle-income families, were more likely to be underinsured compared to those with public insurance coverage.
  6. Policy Implications: The study emphasizes the need for policy measures to address the unique challenges faced by families with CSHCN, especially in the middle-income bracket. There is a call for continuous evaluation and modification of public health insurance programs to better serve this population.

Exploring the Widespread Challenge of Underinsurance in the US

In addition to the issues faced by CSHCN, a Fior Reports article by Becca Roberts sheds light on the broader context of underinsurance in the US. According to a 2023 Commonwealth Fund report, 43% of working-age adults were underinsured in 2022. This includes the uninsured, those with gaps in coverage, or those with plans that don’t adequately cover healthcare needs. Many insured individuals still face high out-of-pocket costs, particularly for prescription medications.

Roberts highlights the widespread insecurity of the healthcare system, with nearly one in five American households incurring medical debt. For those with medical debt, the average owed amount is approximately $2,000, and households without adequate insurance coverage are more likely to have medical debt. Furthermore, medical bills are a significant factor in about 530,000 bankruptcy filings each year in the US.

The JAMA study acknowledges certain limitations, including its reliance on parent perceptions for measures of health insurance adequacy and the categorization based on health consequences and medical complexity rather than diagnosis. Nonetheless, the study’s authors conclude that underinsurance is more prevalent among CSHCN with complex conditions, particularly in middle-income households, as well as among children with mental or behavioral conditions. They assert the necessity of ongoing evaluations and modifications in public health insurance program design and eligibility to adequately meet the needs of CSHCN as healthcare and insurance costs continue to escalate.


Resource: Pharmexec, January 04, 2023

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