Mary Beth Zeni
Ursuline College
Dr. Mary Beth Zeni completed a Doctor of Science from the University of Pittsburgh Graduate School of Public Health in 1993. Since then she has held research positions at University of Pittsburgh and Florida Department of Health focusing on access to health care. Previous academic positions include University of Pittsburgh and Florida State University; she is currently an associate professor at Ursuline College Graduate Nursing Program in the Cleveland, Ohio area.
Background: Since 2001, the US government has collected population-based data about children with chronic conditions through the National Survey of Children with Special Healthcare Needs (NS-CSHCN). A new follow-up survey from the 2009/10 NS-CSHCN, the 2011 Survey of Pathways to Diagnosis and Services (Pathways), was developed to identify children diagnosed with autism spectrum disorder (ASD), developmental delay, or intellectual disability. Pathways, with a nationally representative sample of children 6 – 17 years old, consists of de-identified data addressing topics such as parental concerns/perceptions, diagnostic experiences, services/needs, insurance adequacy, and functioning.
Aim and Objectives: The aim of this study was to identify factors that place a child/adolescent living with ASD at risk for unmet health care needs using the Aday and Andersen Access to Health Care Framework (Framework). The objectives were to describe prevalence and quantify risk factors regarding unmet needs.
Method: A sub-sample of children/adolescents with ASD was used for analysis (rates and regression modeling). The dependent variable, unmet health care need, was derived from two questions addressing children/adolescents not receiving needed treatments/services and not seeing needed service providers. Independent variables were identified from the Framework: race, ethnicity, poverty level, health insurance coverage, Medicaid-reimbursed services, currently on ASD medications, and currently receiving ASD specialty services. R software was used for the analysis. Study was reviewed by author's college Institutional Review Board as exempt status.
Findings: About 34% of children/adolescents with ASD (n = 621,219, weighted) had an unmet need. After adjusting for race (Black), ethnicity (Hispanic), Medicaid-reimbursement, ASD medications, and ASD services, lack of health insurance was significant (≤ 0.05) with risk ratio of 4.7 (confidence intervals = 1.8-12.3).
Conclusions and Implications: Lack of adequate health insurance is a significant driver of unmet health care need. This modifiable finding has important policy implications especially as adolescents transition to adult healthcare services.
