Economic impact on families caring for children with special health care needs in New Hampshire: the effect of socioeconomic and health-related factors

To describe the economic impact on families of caring for children with special health care needs (CSHCN), and to determine the relative contributions of socioeconomic and health-related factors to these impacts on families in the State of New Hampshire. Seven hundred and fifty families with CSHCN in New Hampshire were interviewed in the National Survey of Children with Special Health Needs. Among respondents with CSHCN, univariate and bivariate analyses were conducted to examine economic impact and independent factors (income, insurance type, and impact of condition). Multiple logistic and linear regression models were used to examine relationships between impact and independent factors, controlling for race/ethnicity. Compared to typical children, CSHCN were more likely to have public insurance (12% and 21%, respectively) and less likely to live in higher income families (56% and 48%, respectively). Among CSHCN, nearly one-quarter were greatly affected by their condition, 31% had inadequate insurance, families of 21% had financial problems, parents of 27% had to cut work hours, and almost 15% needed professional care coordination. Adjusting for other factors in regression models, the impact of the condition was associated with all measures of impact, insurance type was associated with out-of-pocket costs, and income was associated with the total number of impacts. Parents of children who are usually or always affected by their conditions were 14 times more likely than those who are never affected to need care coordination. A family's need for support services, and particularly for care coordination, may depend less on the family's means than on the impact of their child's condition.