Rural/Urban Differences in Barriers to and Burden of Care for Children With Special Health Care Needs

TLDR

The study examines barriers and burdens faced by rural families of children with special health care needs and identifies policy actions—enhancing insurance coverage and expanding provider availability—to promote equity. Using the National Survey of Children with Special Health Care Needs, the authors compared rural and urban families on provider use, unmet care needs, insurance and financial challenges, and caregiving burden, reporting both unadjusted and adjusted analyses. Rural children with special health care needs are less likely to see a pediatrician, experience more unmet needs from transportation or provider shortages, and their families face greater financial strain and home caregiving responsibilities, reflecting socioeconomic and health system disparities.

Abstract

ABSTRACT: Purpose: To examine the barriers and difficulties experienced by rural families of children with special health care needs (CSHCN) in caring for their children. Methods: The National Survey of Children with Special Health Care Needs was used to examine rural‐urban differences in types of providers used, reasons CSHCN had unmet health care needs, insurance and financial difficulties encountered, and the family burden of providing the child’s medical care. We present both unadjusted and adjusted results to allow consideration of the causes of rural‐urban differences. Findings: Rural CSHCN are less likely to be seen by a pediatrician than urban children. They are more likely to have unmet health care needs due to transportation difficulties or because care was not available in the area; there were minimal other differences in barriers to care. Families of rural CSHCN are more likely to report financial difficulties associated with their children’s medical needs and more likely to provide care at home for their children. Conclusions: Examining results from both unadjusted and adjusted odds ratios shows that the burden of care for families of rural CSHCN stems both from socioeconomic differences and health system differences. Policies aimed at achieving equity for rural children will require focusing on both individual factors and the health care infrastructure, including increasing insurance coverage to lessen financial difficulties and addressing the availability of providers in rural areas.