Unmet Needs for Health Care Services: An Analysis of Children with Special Health Care Needs in Rural Areas

Funder:	Office of Rural Health Policy (ORHP)
Research center:	North Carolina Rural Health Research and Policy Analysis Center Phone: 919.966.5541
Lead researcher:	Rebecca T. Slifkin, PhD
Project completed:	August 2004
Topics:	Children Dental health Disabilities Health services

Parental report of having an unmet need for care is frequently used as a measure of poor access to medical services; however, this unvalidated measure is usually dependent on parental perceptions of need for care. This project will assess the extent to which children with special health care needs (CSHCN) who live in rural areas and/or are covered by Medicaid are less likely to perceive a need for routine and specialty physician care than their metropolitan and privately insured counterparts, respectively.

With the current state budget crises and the threats to state Medicaid and SCHIP programs, it is essential to understand how CSHCNs, especially those with reduced access due to geographic or financial barriers, fare with regard to meeting their needs for health care. This project will focus especially on dental services and mental health care. The National Survey of CSHCNs will be used to perform analyses of perceived need for routine and specialty care among this population. The following topics will be explored:

• Are CSHCNs residing in rural areas significantly less likely to perceive the need for routine and specialty medical care than those living in metropolitan areas?
• Are CSHCNs who receive Medicaid less likely to perceive the need for these services than those with private insurance?
• Are CSHCNs without insurance less likely to perceive the need for health care than children with insurance?

The same data source will be used to assess the extent to which CSHCN who live in rural areas and/or are covered by Medicaid face greater risks of having unmet needs for specific types of health care services than their metropolitan and privately insured counterparts, respectively. Findings will be presented in two research papers.

Publications

• Effect of Rural Residence On Dental Unmet Need for Children With Special Health Care Needs
  Author(s): Asheley Cockrell Skinner, Rebecca T. Slifkin, Michelle L. Mayer
  Citation: Journal of Rural Health, 22(1), 36-42
  Date: 2006
  Unmet need for dental care is the most prevalent unmet health care need among children with special health care needs (CSHCN), even though these children are at a greater risk for dental problems. The combination of rural residence and special health care needs may leave rural CSHCN particularly vulnerable to high levels of unmet dental needs. Rural CSHCN are more likely to forgo needed dental care than their urban counterparts. Results suggest that rural CSHCN have unmet needs for dental care due to both difficulty accessing care and because their parents do not recognize a need.
• Rural/Urban Differences in Barriers to and Burden of Care for Children With Special Health Care Needs
  Author(s): Asheley Cockrell Skinner, Rebecca T. Slifkin
  Citation: Journal of Rural Health, 23(2), 150-157
  Date: 2007
  Examines the barriers and difficulties experienced by rural families of children with special health care needs in caring for their children. Covers rural-urban differences in types of providers used, reasons for unmet health care needs, insurance and financial difficulties encountered, and the family burden of providing the child's medical care.