Reasons for unmet need for child and family health services among children with special health care needs with and without medical homes

PLoS One. 2013 Dec 10;8(12):e82570. doi: 10.1371/journal.pone.0082570. eCollection 2013.


Objectives: Medical homes, an important component of U.S. health reform, were first developed to help families of children with special health care needs (CSHCN) find and coordinate services, and reduce their children's unmet need for health services. We hypothesize that CSHCN lacking medical homes are more likely than those with medical homes to report health system delivery or coverage problems as the specific reasons for unmet need.

Methods: Data are from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN), a national, population-based survey of 40,723 CSHCN. We studied whether lacking a medical home was associated with 9 specific reasons for unmet need for 11 types of medical services, controlling for health insurance, child's health, and sociodemographic characteristics.

Results: Weighted to the national population, 17% of CSHCN reported at least one unmet health service need in the previous year. CSHCN without medical homes were 2 to 3 times as likely to report unmet need for child or family health services, and more likely to report no referral (OR= 3.3), dissatisfaction with provider (OR=2.5), service not available in area (OR= 2.1), can't find provider who accepts insurance (OR=1.8), and health plan problems (OR=1.4) as reasons for unmet need (all p<0.05).

Conclusions: CSHCN without medical homes were more likely than those with medical homes to report health system delivery or coverage reasons for unmet child health service needs. Attributable risk estimates suggest that if the 50% of CSHCN who lacked medical homes had one, overall unmet need for child health services could be reduced by as much as 35% and unmet need for family health services by 40%.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Child Health Services*
  • Child, Preschool
  • Delivery of Health Care*
  • Family Health*
  • Female
  • Health Care Reform*
  • Humans
  • Male
  • Patient-Centered Care*
  • Risk Factors
  • United States

Grant support

This study was supported by the ordinary budget of the Institute for Health, Health Care Policy, and Aging Research, Rutgers University. There was no external funding. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.