Unmet Need for Care Coordination Among Children with Special Health Care Needs
Abstract
Socioeconomic disparities in access to care coordination have been noted among children with special health care needs (CSHCN). Following recent policy developments and technological innovation, care coordination has become more widespread, possibly leading to reduced disparity in care coordination access. This study investigates whether child and household characteristics remain associated with unmet need for care coordination among CSHCN. CSHCN (aged <18 years) requiring ≥2 types of health services in the past year were identified in the 2016 National Survey of Children's Health (NSCH). Care coordination was defined as help with arranging the child's care among different doctors or services. Children were classified as not needing care coordination, receiving sufficient care coordination (met need), or needing but not receiving care coordination (unmet need). Weighted multinomial logistic regression examined the association of child characteristics with this outcome. The analysis included 5622 children with no need for care coordination, 1466 with a met need, and 980 with unmet needs. Children with mental health conditions were more likely to have unmet rather than met needs for care coordination (odds ratio = 4.1; 95% confidence interval: 2.7, 6.1; P < 0.001). After multivariable adjustment, race/ethnicity, income, family structure, insurance coverage, place of birth, and use of English in the home were not associated with having unmet rather than met needs for care coordination. Among CSHCN, the latest data from NSCH reveal no evidence of previously described socioeconomic disparities in access to care coordination. Nevertheless, unmet needs for care coordination remain prevalent, especially among children with mental health conditions.
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Current evidence fails to distinguish between potential explanations such as whether integrated care improves access universally leading to increased service use and costs, and/or whether integrated care uncovers unmet needs and thereby appropriately leads to higher costs.
“However, current evidence also fails to distinguish between potential explanations such as whether integrated care improves access universally leading to increased service use and costs, and/or whether integrated care uncovers unmet needs39 and thereby appropriately leads to higher costs.”
From Integrated care for children and young people with special health and care needs: a systematic review (2024) · cites this paper as [39]
Compared to children with other types of complex healthcare needs, children with mental health conditions are less likely to receive adequate care coordination.
“compared to children with other types of complex healthcare needs, children with mental health conditions are less likely to receive adequate care coordination (Miller et al., 2018).”
From Adequate Care Coordination is Associated with Reduced Unmet Mental Health Needs for Children (2026) · cites this paper as Miller et al., 2018
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- Authors
- Miller, R., Tumin, D., Hayes, D., Uffman, J. C., Raman, V. T., & Tobias, J. D.
- Affiliations
- Nationwide Children's Hospital (US)
- Corresponding author
- Miller, Rebecca
- Venue
- Population Health Management
- Publisher
- SAGE Publications
- Published
- 2019-05-30
- Volume
- 22
- Issue
- 3
- Pages
- 255-261
- ISSN
- 1942-7891 (ISSN-L)
- 1942-7905
- OpenAlex
- W2895037352
- Cited by
- 33
- References
- 30
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 5 · 2023: 5 · 2022: 3 · 2021: 8 · 2020: 3 · 2019: 2
- FWCI
- 5.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Population Health Management (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
- Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- care coordination, children with special health care needs, unmet needs, socioeconomic disparities, mental illness, health care access, National Survey of Children's Health, family structure, insurance coverage, race and ethnicity
- MeSH terms
- Adolescent, Mental Disorders, Child, Child Health Services, Continuity of Patient Care, Female, Health Services Accessibility, Health Services Needs and Demand, Humans, Male, Mental Health Services, United States, Children with Disabilities, Disabled Children, Needs Assessment
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