Core Outcomes: Key Measures of Performance

Families of CSHCN have adequate private and/or public insurance to pay for the services they need.

Health insurance coverage plays a critical role in ensuring access to family-centered care for CSHCN. For children, gaps in health care financing may mean that health care is delayed or that services are not delivered. Uninsured and underinsured children are less likely to receive care in a medical home that addresses their comprehensive needs. The availability of private or public insurance is strongly associated with the ability to obtain community-based services such as medical care, dental care, mental health services, medical equipment, supplies and prescriptions. Although Medicaid and the Children’s Health Insurance Program (CHIP) have made a significant contribution to decreasing the number of uninsured children, the problem of underinsurance persists.

Adequacy of insurance was assessed using three questions: whether or not health insurance benefits met the child’s needs, whether noncovered charges were reasonable, and whether the plan allows the child to see the providers he or she needs. In addition, children without any insurance at the time of the survey or at any time in the past year were considered not to have adequate insurance. Overall, this outcome was achieved by 62.0 percent of CSHCN. The likelihood of achieving this outcome varied somewhat by the impact of the child’s condition on his or her functional ability (from 54 percent of children who were affected usually, always, or a great deal to 70 percent of children who were never affected) and by family income (from 57 percent of children in poverty to 69 percent of children with family incomes of 400 percent of poverty or more).

Back to Top