Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

(SDAS) Impact of family health care financial burden on health care access and utilization of children

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Project Number: R40 MC 17161-01
Grantee: Regents of the University of Minnesota
Department/Center: Health Policy and Management/School of Public Health
Project Date: 2/1/2010

Final Report

(SDAS) Impact of family health care financial burden on health care access and utilization of children Final Report (PDF) Exit Disclaimer

Principal Investigator

Pinar Karaca-Mandic, PhD
Assistant Professor
420 Delaware Street SE
Minneapolis, MN  55455-0341
Phone: (612) 624-8953


  • Perinatal/Infancy (0-12 months)
  • Toddlerhood (13-35 months)
  • Early Childhood (3-5 years)
  • Middle Childhood (6-11 years)
  • Adolescence (12-18 years)


In spite of numerous initiatives to expand health insurance coverage and to assure coordinated and family centered care, many children, including those with chronic conditions and special health care needs, continue to receive inadequate health care services. The long term goal of this research is to improve the health-related quality of life for children, especially those with chronic conditions and special needs by identifying barriers to receiving needed health care and informing policy options for the organizing and financing of children's health care. The objective of this proposed project is to explore opportunities in the Medical Expenditure Panel Survey (MEPS) dataset for the explicit purpose of studying a previously unexplored dimension of potential barriers to children's health care utilization. Recently, there has been a rather sharp trend toward deteriorating private coverage and increasing family healthcare financial burden especially for the adults in the family. We aim to explore the implications of family health care financial burden on the health care access and utilization of children. The central hypothesis we propose is that models of household health care needs and financial burden of health care will provide greater insights into children's health care access and utilization. For example, children in households where other members of the household have higher health care costs, and thus high financial burden may have less access to health care services. This research fits well in the Maternal and Child Health Bureau's strategic research issue #4: Promoting the healthy development of MCH populations. The proposed study is a first step in investigating the importance of family out-of-pocket health care burden on health care resource allocations within the household by specifically focusing on its impact for children, and in understanding how families react to major medical conditions that may cause significant financial burden on the family. Our specific aims are to examine the impact of out-of-pocket health care costs of other family members on children's 1) Access to health care services as measured by Access to usual source of care Access to a usual primary care provider Delayed or unmet need for medical care or prescription drugs 2) Utilization and expenditures of health care services that are most likely to be subject to increased household financial burden such as Office-based medical provider visits Prescription medicines In both aims, we will conduct analyses for all children between ages 0-18 and their families. We will investigate how the effects of family out-of-pocket burden may vary across age groups as concerns for very young children are likely different than the older ones. We will also conduct analyses focusing on children with special health care needs and their families.


Listed is descending order by year published.

Karaca-Mandic P, Choi-Yoo SJ, Lee J, Scal P. Family out-of-pocket health care burden and children's unmet needs or delayed health care. Acad Pediatr. Jan-Feb;14(1):101-8.

Karaca-Mandic P, Yoo SJ, Sommers BD. Recession led to a decline in out-of-pocket spending for children with special health care needs. Health Aff (Millwood). 2013 Jun;32(6):1054-62. doi:10.1377/hlthaff.2012.1137. PubMed PMID: 23733979.


Chronic Illness, Special Health Care Needs, Insurance Coverage, Access to Health Care, Health Care Utilization, Health Care Costs

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