Financial Effects on Families of Children With Special Needs
Financial Effects on Families of Children With Special Needs
The results summarized in this literature review have important implications for clinical practice and for health care policy advocacy efforts. Literature reviews provide a synthesis of the evidence to inform both practitioners and those involved in policy reform movements about recent research results.
The results found in this review demonstrate that having health insurance is related to lower out-of-pocket medical costs for families. The same is true for being enrolled in a public health insurance program versus a private one. These correlations point to several very important policy implications. The first is the need to provide health insurance coverage to children with special health care needs. The Health Care and Education Reconciliation Act became law in 2010 and will possibly provide more health insurance options for families that had struggled to purchase insurance and to cover children with pre-existing conditions (Kasier Family Foundation, 2010). As of September 2010, health insurers are no longer be able to exclude children from coverage because of pre-existing conditions. Nor will there be a lifetime limit on benefits for children (Kaiser Family Foundation, 2010.) Both of these elements of the reform should help to expand coverage for children with special health care needs.
The second policy implication is the need for mental health parity in private health insurance because it was found that often families with children with mental health conditions had a higher financial burden. Recently action on overcoming this disparity has been taken with the passage and enactment of the federal Mental Health and Substance Abuse Parity law. The law passed in October 2008 and went into effect in January 2010 (National Alliance for the Mentally Ill, 2009). The legislation mandates that private health insurance plans that offer mental health benefits must offer benefits on par with those provided for physical health conditions. Thus an insurance company cannot impose higher deductibles, copayments, coinsurance, or out-of-pocket expenses on persons with mental health and substance abuse conditions. Furthermore, companies are prohibited from imposing different treatment limitations, including frequency of treatment, number of visits, days of coverage, or any other similar limits (National Council for Community Behavioral Healthcare, 2010). This new legislation may reduce out-of-pocket costs for families and should be tracked and studied as it is implemented.
This review summarized results that found that families raising children with autism spectrum disorders have some of the highest out-of-pocket costs and employment reductions. Significant policy reforms are still needed to provide better coverage of the needed treatment for children with autism spectrum disorders because the mental health parity law may not cover all needed treatments. Many state legislatures are currently fighting for these reforms, and 15 states already mandate that insurance companies cover treatment for autism (National Conference of State Legislatures [NCSL], 2010).
This review of the literature found that receiving care in a medical home protects parents from high out-of-pocket costs and reductions in employment. Especially important seems to be the receipt of care coordination assistance. Although no national model of care coordination exists, many larger pediatric practices that take a team approach to health care are providing this service, either by a nurse or a medical social worker (Antonelli et al., 2008, Backer, 2009, McAllister et al., 2007). Pilot projects that analyze whether receiving care coordination lowers costs, both to families and to the medical system overall, are needed. Policy reform that supports widespread adoption of the medical home model may eventually help control costs for families and the health care system overall.
This literature review revealed a significant reliance on cross-sectional study designs. Only two studies utilized a longitudinal design (Parish et al., 2004, Seltzer et al., 2001). Even though the confounding variables are controlled for statistically, it is difficult to make causal conclusions. More studies that track outcomes over a longer period are needed to strengthen this area of research. A second limitation is the over-reliance on the NSCSHCN, as well as the dominance of several authors who are repeatedly analyzing and publishing articles in this field. However, because the dataset is so broad, researchers are able to analyze by condition (diagnosis and severity) to provide a rich and deep knowledge of how families are affected by having CSHCNs. With that said, the research could be richer, with a more diverse set of researchers analyzing this population. Another important note on the NSCSHCN is that it is a national survey of families that relies entirely on parental report. Parents may or may not be the best reporters of the elements of a child's health service experience. The research would be stronger if other key players, especially health care providers, were included. Finally, a standard set of questions that defines a medical home is needed across national health surveys, which would allow for more generalizable results.
Discussion
The results summarized in this literature review have important implications for clinical practice and for health care policy advocacy efforts. Literature reviews provide a synthesis of the evidence to inform both practitioners and those involved in policy reform movements about recent research results.
Policy Implications
The results found in this review demonstrate that having health insurance is related to lower out-of-pocket medical costs for families. The same is true for being enrolled in a public health insurance program versus a private one. These correlations point to several very important policy implications. The first is the need to provide health insurance coverage to children with special health care needs. The Health Care and Education Reconciliation Act became law in 2010 and will possibly provide more health insurance options for families that had struggled to purchase insurance and to cover children with pre-existing conditions (Kasier Family Foundation, 2010). As of September 2010, health insurers are no longer be able to exclude children from coverage because of pre-existing conditions. Nor will there be a lifetime limit on benefits for children (Kaiser Family Foundation, 2010.) Both of these elements of the reform should help to expand coverage for children with special health care needs.
The second policy implication is the need for mental health parity in private health insurance because it was found that often families with children with mental health conditions had a higher financial burden. Recently action on overcoming this disparity has been taken with the passage and enactment of the federal Mental Health and Substance Abuse Parity law. The law passed in October 2008 and went into effect in January 2010 (National Alliance for the Mentally Ill, 2009). The legislation mandates that private health insurance plans that offer mental health benefits must offer benefits on par with those provided for physical health conditions. Thus an insurance company cannot impose higher deductibles, copayments, coinsurance, or out-of-pocket expenses on persons with mental health and substance abuse conditions. Furthermore, companies are prohibited from imposing different treatment limitations, including frequency of treatment, number of visits, days of coverage, or any other similar limits (National Council for Community Behavioral Healthcare, 2010). This new legislation may reduce out-of-pocket costs for families and should be tracked and studied as it is implemented.
This review summarized results that found that families raising children with autism spectrum disorders have some of the highest out-of-pocket costs and employment reductions. Significant policy reforms are still needed to provide better coverage of the needed treatment for children with autism spectrum disorders because the mental health parity law may not cover all needed treatments. Many state legislatures are currently fighting for these reforms, and 15 states already mandate that insurance companies cover treatment for autism (National Conference of State Legislatures [NCSL], 2010).
Clinical Implications
This review of the literature found that receiving care in a medical home protects parents from high out-of-pocket costs and reductions in employment. Especially important seems to be the receipt of care coordination assistance. Although no national model of care coordination exists, many larger pediatric practices that take a team approach to health care are providing this service, either by a nurse or a medical social worker (Antonelli et al., 2008, Backer, 2009, McAllister et al., 2007). Pilot projects that analyze whether receiving care coordination lowers costs, both to families and to the medical system overall, are needed. Policy reform that supports widespread adoption of the medical home model may eventually help control costs for families and the health care system overall.
Limitations
This literature review revealed a significant reliance on cross-sectional study designs. Only two studies utilized a longitudinal design (Parish et al., 2004, Seltzer et al., 2001). Even though the confounding variables are controlled for statistically, it is difficult to make causal conclusions. More studies that track outcomes over a longer period are needed to strengthen this area of research. A second limitation is the over-reliance on the NSCSHCN, as well as the dominance of several authors who are repeatedly analyzing and publishing articles in this field. However, because the dataset is so broad, researchers are able to analyze by condition (diagnosis and severity) to provide a rich and deep knowledge of how families are affected by having CSHCNs. With that said, the research could be richer, with a more diverse set of researchers analyzing this population. Another important note on the NSCSHCN is that it is a national survey of families that relies entirely on parental report. Parents may or may not be the best reporters of the elements of a child's health service experience. The research would be stronger if other key players, especially health care providers, were included. Finally, a standard set of questions that defines a medical home is needed across national health surveys, which would allow for more generalizable results.
Source...