Minnesota Title V MCH Needs Assessment Fact Sheets

Children with Special Health Needs

Access to Specialty Care and Services

Summer 2004

Printer-Friendly Version (PDF: 58KB/3 pages)

Size of the Problem

Children with special health care needs require access to a variety of specialized services. Of those children who needed specific specialty services in Minnesota, 22,698 (14.1%) have one or more unmet needs for specific health care services [1].

  • An estimated 6,341 children and youth with special health care needs did not get all needed mental health care;
  • 4,334 didn't get needed specialty physician care;
  • 2,562 didn't get needed therapies;
  • 3,935 didn't get needed vision services;
  • 1,338 didn't get needed hearing services;
  • 1,320 didn't get needed medical supplies;
  • 1,050 didn't get needed communication devices.

Children in Minnesota were less likely than those in other states in the region (with the exception of Wisconsin) to be uninsured for all or part of 2001. This suggests that lack of health care coverage is not solely responsible for the presence of unmet needs [2].

Seriousness

While Minnesota compares favorably to the nation as whole in the percentage of children with unmet needs for services, it ranks last in the Upper Midwest.

An analysis and comparison of unmet need by age grouping among states within the Upper Midwest Region revealed that all other states did a better job of meeting all health care needs among children birth to five years old than did Minnesota.

State

Percentage of CSHCN with One or More Unmet Need for Specific Health Care Services

Iowa

10.6

South Dakota

10.9

Wisconsin

12.5

North Dakota

12.8

Minnesota

14.1

US

17.7

Children in rural areas are less likely to have access to specialty care due to professional shortages. However, rural areas are not the only areas where CSHCN face difficulties in getting access to specialty and other needed services. Lack of connection to a primary provider - a medical home - negatively affects urban CSHCN as well. The Starfield and Shi literature review notes that increased Medicaid eligibility leads to more coverage and greater presence of a regular source of care. However, black children are more likely to use poor regular sources of care. Thus, just providing insurance may increase disparities between population subgroups unless good sources of primary care are available [3].

Children who have a medical home are more likely than those without one to have their need for other services met [4].

Relationship of Having a Medical Home to Unmet Needs

Medical Home Status

No Unmet Needs (%)

No Medical Home

81.1

With Medical Home

92.2

Failure to receive needed specialty care and services impacts both child and family negatively. Lack of appropriate equipment for instance, increases the caregiving burden both at home and at school. Lack of needed hearing, vision and therapy services decreases the likelihood that the child will reach his or her full potential and increases the likelihood the child will remain dependent on others into adulthood. Lack of specialty care and mental health services may result in an improper diagnosis and ineffective treatment regimens.

Interventions

Telemedicine is one methodology that has been used successfully in reaching CSHCN in rural, medically underserved communities with subspecialty care. Research reveals that of 130 telemedicine consultations with 55 CSHCN, overall satisfaction with telemedicine care was rated either "excellent" or "very good," and all but 2 of the rural providers' surveyed reported satisfaction with telemedicine as "excellent" or "very good" [5].

In the Minnesota Department of Health's 2004 Minnesota Rural Health Plan, reported that the "potential for telecommunications to improve access to health in rural areas in Minnesota is promising." Given the shortage of health professionals and resources in greater Minnesota, a modern telecommunications infrastructure is considered to be the future of medicine in rural areas [6].

Starfield and Shi point to data from a path analysis that examined the relationship between primary care physician supply and various measures of health at the state level in all 50 states. This analysis found that the more primary care physicians, the lower the total mortality, postneonatal mortality, total infant mortality, and stroke mortality, and the greater the life expectancy – even when income inequality in the states was included in the analysis [7]. Minnesota is currently testing a care improvement model that will assist primary care providers identify and coordinate services for children with special health care needs in their practices.

The data are becoming much more clear on the importance of primary care in health indicators - including access to other needed services than those provided by the primary practitioner.

Finally, in another set of studies reviewed in the Starfield and Shi article, it was noted that care received in community health centers (federally qualified health centers) is associated with better outcomes than is the case for comparable populations that have no access to such centers. The percentage of children with age-appropriate interval since their last routine care visit is much greater when they have a particular physician with whom they relate in these centers (88%) than when they have no specific clinician (82%), have a non-CHC place where they receive care (80%) or have no sick care site (76%) [8].

The evidence in support of policies that encourage higher ratios of primary care physicians to the population is very strong.

The Minnesota Children with Special Health Needs Program (MCSHN) provides either directly or through contracts, specialty care for over 450 children per year. Clinic types include Facial/Dental, Development and Behavior, Habilitation Technology and Diabetes Clinics. Preliminary analysis of an evaluation of the Development and Behavior Clinics results in parents reporting improved school performance for nearly 80% of the children seen in clinic, improved behavior at school for 75% of the children and improved behavior at home for 73% of the children.

Status

A statewide telehealth collaborative was formed by the Minnesota Department of Human Services. However, this collaborative has been looking primarily at care for older Minnesotans, not children.

Among the goals of the Office of Rural Health in its Plan is to: Seek funding to address infrastructure needs of rural health care facilities and to seek continued support through grants, private and public funding in order to strengthen and promote an integrated rural health system. Another goal of the Office is to "support health professional recruitment efforts."

The Office of Rural Health and Primary Care at the Minnesota Department of Health is continuing its efforts to support the development of integrated health systems for rural areas and the development of primary care in both urban and rural areas.

Minnesota Children with Special Health Needs continues to support specialty clinics in rural Minnesota. The demand for services currently exceeds the supply for some types of services, particularly development and behavior clinics.

References

1. Centers for Disease Control and Prevention, National Center for Health Statistics, State and Local Area Integrated Telephone Survey, National Survey of Children with Special Health Care Needs, 2001
2. ibid
3. Barbara Starfield, M.D., M.P.H. and Leiyu Shi, DrPH, MBA. "The Medical Home, Access to Care, and Insurance: A Review of Evidence" Pediatrics, Supplement, May 2004 (Volume 113, Number 5, Part 2 of 2),
4. ibid
5. Marcin JP, Ellis J, Mawis R, Nagrampa E, Nesbitt T, and Dimand RJ. Using Telemedicine to Provide Pediatric Subspecialty Care to Children With Special Health Care Needs in an Underserved Rural Community. Pediatrics. 2004 Jan: 113(1): 1-6.
6. Office of Rural Health and Primary Care, Minnesota Department of Health. Minnesota's Rural Health Plan. April 2004: 27.
7. Barbara Starfield, M.D., M.P.H. and Leiyu Shi, DrPH, MBA. "The Medical Home, Access to Care, and Insurance: A Review of Evidence" Pediatrics, Supplement, May 2004 (Volume 113, Number 5, Part 2 of 2),
8. Office of Rural Health and Primary Care, Minnesota Department of Health. Minnesota's Rural Health Plan. April 2004: 27.