Parental report of having an unmet need for care is frequently used as a measure of poor access to medical services; however, this unvalidated measure is usually dependent on parental perceptions of need for care. This project will assess the extent to which children with special healthcare needs (CSHCNs) who live in rural areas and/or are covered by Medicaid are less likely to perceive a need for routine and specialty physician care than their metropolitan and privately insured counterparts, respectively.

With the current state budget crises and the threats to state Medicaid and SCHIP programs, it is essential to understand how CSHCNs, especially those with reduced access due to geographic or financial barriers, fare with regard to meeting their needs for healthcare. This project will focus especially on dental services and mental healthcare. The National Survey of CSHCNs will be used to perform analyses of perceived need for routine and specialty care among this population. The following topics will be explored:

• Are CSHCNs residing in rural areas significantly less likely to perceive the need for routine and specialty medical care than those living in metropolitan areas?
• Are CSHCNs who receive Medicaid less likely to perceive the need for these services than those with private insurance?
• Are CSHCNs without insurance less likely to perceive the need for healthcare than children with insurance?

The same data source will be used to assess the extent to which CSHCNs who live in rural areas and/or are covered by Medicaid face greater risks of having unmet needs for specific types of healthcare services than their metropolitan and privately insured counterparts, respectively. Findings will be presented in two research papers.

Publications

• The Effect of Rural Residence On Dental Unmet Need for Children With Special Health Care Needs
  Journal Article
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 2006
  Unmet need for dental care is the most prevalent unmet healthcare need among children with special healthcare needs (CSHCN). The combination of rural residence and special healthcare needs may leave rural CSHCN particularly vulnerable to high levels of unmet dental needs.
• Rural/Urban Differences in Barriers to and Burden of Care for Children With Special Health Care Needs
  Journal Article
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 2007
  Examines the barriers and difficulties experienced by rural families of children with special healthcare needs in caring for their children. Covers rural-urban differences in types of providers used, reasons for unmet healthcare needs, insurance and financial difficulties encountered, and the family burden of providing the child's medical care.