A total of 4,918 CSHCN with private insurance coverage reported a need for mental health care in 2005–2006. We compared the health care experience of these children with: (1) 2,346 privately insured children without SHCN (the referent sample), (2) 16,250 privately insured CSHCN who do not report a need for mental health care, and (3) a subset of group 2 consisting of 7,902 privately insured CSHCN who do not report a need for mental health care but do report a need for specialist care.
Children needing mental health care had greater out-of-pocket costs on average than all three comparison groups (). For example, 61 percent of children needing mental health care reported annual out-of-pocket costs greater than $500 compared with only 19 percent of the referent sample. Less than 1 percent of the referent sample had annual out-of-pocket costs greater than $5,000 compared with 7 percent of the sample needing mental health care. The two groups of CSHCN with no mental health care need (columns 2 and 3), had more families with high out-of-pocket costs than the referent sample, but fewer than CSHCN needing mental health care. Financial outcomes were worse for children with a need for specialty care, compared with children with no need for specialty care.
Results for health plan experience outcomes were similar; children needing mental health care were more likely to have negative health plan experiences than other children. Regarding labor market and time outcomes, CSHCN needing mental health care had caregivers that spent more time arranging and providing care, and these caregivers were more likely to stop work or cut work hours to care for their child.
Examining parent care experience outcomes, parents of children with mental health care needs were more likely than the other three groups to report they were dissatisfied with services received. While almost 14 percent of parents of CSHCN needing mental health care were dissatisfied, only 3 percent of parents of the referent sample were dissatisfied. Parents of CSHCN needing mental health care were more than twice as likely as parents of other CSHCN to report dissatisfaction with services (14 versus 5 percent).
In we present adjusted results. Column 1 reports the odds of each of our outcomes comparing CSHCN with and without mental health care needs. Results are similar to the unadjusted outcomes. For all financial and health plan experience outcomes, CSHCN with mental health care needs faired worse than their counterparts with no mental health care need (column 1), even when comparing to CSHCN with no mental health care need but a need for specialty care (column 2).
Adjusted Outcomes for Privately Insured Children with Special Health Care Needs (CSHCN) by Need for Mental Health Care, 2005–2006
For labor market and time outcomes, we see fewer differences than in the unadjusted results. CSHCN with no mental health care needs but with a need for specialty care were less likely than CSHCN with mental health care needs to spend more than 10 hours a week providing care.
Parents of CSHCN needing mental health care had lower overall patient satisfaction compared with parents of CSHCN with no need for mental health care (OR=1.59) and with parents of CSHCN needing specialty care (OR=1.54). When considering individual components of patient satisfaction (using measures of family centered care), only one component (received specific information from doctors) is significantly different (p<.05) when comparing parents of CSHCN with and without mental health care need.
In columns 3–5 of , we present results for the subset of CSHCN with specific categories of disorders. Generally, we find children with autism experienced the greatest difference in outcomes.
In we compare CSHCN with and without mental health care need within relevant subsamples. In analyses not shown, we also examine these subsamples comparing CSHCN with mental health care need to CSHCN with no mental health care need but with a need for specialty care. In almost all cases, these results are qualitatively similar; we only mention below when results diverge from those in .
column 1 presents results limiting the sample to children in six states with a broad mental health parity law. Somewhat surprisingly, we find that these families have a greater difference in financial outcomes, compared with residents of all states. Otherwise there were few differences between these analyses, and those presented in column 1 (what we refer to below as the full sample). In some cases the odds ratios were similar, but no longer significant due to the smaller sample size. In column 2, we limit the sample to residents of states with adequate supply of child psychiatrists. Generally, results are similar to the full sample in . One exception is the patient satisfaction variables. In this subsample, there are fewer differences in patient satisfaction between those with and without mental health care needs. In all cases, the point estimate suggests those with no mental health care have similar or greater satisfaction.
In , column 4, results for the subsample with no prescription drug needs are reported. This sample is much smaller than the full sample on , and may represent children with different health care needs and health status. We detect differences in financial outcomes comparing those with and without mental health care need similar in magnitude to the full sample. However, within this subsample, comparing children with mental health care need to CSHCN with no need for mental health care but with a need for specialty health care (results not shown) differences in financial outcomes are not found. This suggests that, at least among those with no prescription drug needs, there are few differences in the financial burden between those with and without a need for mental health care. Finally, Table 4 column 5 indicates results for the subsample of children whose conditions are usually stable. We find few differences compared with the full sample.