Few people would disagree that children with disabilities need adequate health insurance. But what kind of health insurance coverage would be optimal for these children? Peter Szilagyi surveys the current state of insurance coverage for children with special health care needs and examines critical aspects of coverage with an eye to helping policy makers and clinicians improve systems of care for them. He also reviews the extent to which insurance enhances their access to and use of health care, the quality of care received, and their health outcomes.

Szilagyi begins by noting that nearly 9 percent of children with disabilities are uninsured for all or part of a year and that coverage even for many such children with insurance is inadequate—either not meeting their needs or not adequately covering the costs of care. By one estimate, nearly two of every five special needs children are either uninsured or inadequately insured.

The author finds strong evidence that health insurance improves access to health care. Children with disabilities who are insured are more likely than those who are uninsured to have a primary care provider, to be able to reach a specialist, and to have access to supporting services. They also have fewer unmet needs for medical and oral health care and receive care more quickly. The bulk of the evidence shows that insurance improves quality of care for children in general and for children with disabilities. Parents of insured children with chronic conditions are more satisfied with their children's primary care, medications, specialty care, and overall health care than are parents of their uninsured peers. A handful of studies of specific diseases have found insurance to be related to improvements in quality measures, such as more doctor visits and greater continuity of care.

In conclusion, Szilagyi stresses the need to provide adequate health insurance to all children with disabilities and to develop a set of best practices in health insurance to cover important services needed by this population. To that end, implementation of the federal health care reform act, including the mandate for insurance coverage, is important. He also urges support for medical home and other quality initiatives and better ways to monitor quality and health outcomes to ensure that children with disabilities receive cost-effective and equitable care.


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pp. 123-148
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