The effect of poverty and caregiver education on perceived need and access to health services among children with special health care needs

Am J Public Health. 2007 Feb;97(2):323-9. doi: 10.2105/AJPH.2004.055921. Epub 2006 Dec 28.


Objectives: We examined the association between several variables and the use of specialist physician services, developmental therapies, and prescription medications among children with special health care needs (N=38866).

Methods: We used a bivariate probit model to estimate whether a given child needed specialized services and whether that child accessed those services; we controlled for activity limitations and severity of special needs. Variables included family income, mother's (or other caregiver's) educational level, health insurance coverage, and perceived need for specialized services. We used data from the 2001 National Survey of Children with Special Health Care Needs.

Results: Lower-income and less-educated parents were less likely than higher-income and more-educated parents to say their special needs children needed specialized health services. The probability of accessing specialized health services-when needed-increased with both higher family income and insurance coverage.

Conclusions: Children with special health care needs have less access to health services because their parents do not recognize the need for those services. An intervention in the form of information at the family level may be an appropriate policy response.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Caregivers / education*
  • Caregivers / psychology
  • Child
  • Child Health Services / statistics & numerical data*
  • Child, Preschool
  • Disabled Children / statistics & numerical data*
  • Educational Status
  • Female
  • Health Care Surveys
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Infant
  • Infant, Newborn
  • Insurance Coverage
  • Male
  • Medicine
  • Models, Statistical
  • Needs Assessment*
  • Parents / education*
  • Parents / psychology
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Poverty
  • Specialization
  • United States