There are gaps in State Health Insurance Programs (SCHIP), which affect the health of Children with Special Health Care Needs (CSHCN) because they are vulnerable to chronic conditions and require continuous care (Hollar, 2012). However, few studies have investigated how these health gaps affect access to health care for this vulnerable population group.
Gaps in health insurance are detrimental to CSHCN because they are a vulnerable population with many health care needs. According to Bhattacharya (2013), more than 9% of this population reported having been uninsured within the past year. Low-income groups often depend on Medicaid and SCHIP programs for health insurance services. However, these programs have significant differences in their design and the type of rights they accord to their beneficiaries. Nonetheless, a myriad of challenges in health education and social policies have made it difficult for these programs to provide health insurance, as they should do (Hollar, 2012). This is why there are some duplicated services in some areas of health insurance and inherent gaps in others (Hollar, 2012).
The current government policy on access to health care services for CSHCN centers on promoting equality when accessing health care services. To achieve this goal, independent states and federal governments have two distinct roles in the provision of health care services. States control the SCHIP, while the federal government controls Medicaid. Under the SCHIP, different states could expand their Medicaid programs, start a separate health insurance program, or adopt a strategy that combines the two (Bhattacharya, 2013).
Comprehensively, the government’s policy on health care for CSHCN is that the federal government takes a leading role in providing health services while states provide supplementary care for the same. All these efforts strive to provide adequate access to vulnerable populations. However, they have glaring inefficiencies.
The direct and indirect health costs of failing to provide adequate health insurance coverage for CSHCN depend on understanding the overall health costs of not ensuring this demographic. The direct cost of failing to ensure CSHCN could affect more than 33% of the total cost of providing health care to children because CSHCN health care needs account for more than 33% of the total health care cost in America (Bhattacharya, 2013).
The indirect costs associated with this public health issue would also increase if there were no solution because gaps in health insurance for CSHCN would cause an increase in out-of-pocket expenses, social costs, and lost opportunities for families of CSHCN. Direct costs would also increase if nothing is done to address this health issue because there would be an increase in payment of health services and specific goods if this health issue is not addressed (Tudor-Edwards, Charles, & Lloyd-Williams, 2013).
When vulnerable populations do not get access to health care services because of narrow policies in SCHIP and Medicaid services, they have to bear the cost of seeking health services (usually out-of-pocket). When stakeholders allow this problem to continue unabated, the huge financial burden placed on individual families exceeds the cost of implementing the health programs in the first place (Tudor-Edwards et al., 2013). Furthermore, it may obscure the benefits of implementing such programs.
A deeper analysis of this issue reveals that since the cost of underinsuring CSHCN amounts to more than 33% of the total health care cost associated with this patient group, correctly, we could predict that solving this public health issue would create economic cost improvements of up to the same percentage of health care costs within this demographic. Therefore, the total cost savings of managing this health issue could reduce the total cost of health care for CSHCN to less than 33% because this percentage is the maximum cost of health care services associated with this demographic when there are gaps in health insurance. Therefore, the best way to reduce health care gaps is to improve the efficiency of existing health programs.
Current interventions to fill the health insurance gaps center on expanding Medicaid programs to cover uninsured populations. According to Bhattacharya (2013), the success of such interventions stems from eliminating rigid Medicaid guidelines imposed by the federal government, which exacerbates the problem in the first place. Another existing strategy is introducing separate SCHIP programs that offer more flexibility in their implementation strategies, thereby accommodating more people in health insurance programs.
An alternative intervention for managing the public health issue is to provide a comprehensive and continuous care plan for CSHCN. This plan should have mandatory benefits, such as early periodic screening. This alternative strategy has had some significant level of success in meeting the health care needs of families with unmet needs (Bhattacharya, 2013). Amending the SCHIP is also another plausible strategy.
Recommendations are rife to introduce a comprehensive health benefits package within each state that is commensurate with the health care needs of the jurisdiction. Similarly, there are proposals to introduce a sliding fee for all health programs aimed at benefitting CSHCN to eliminate the possibility that beneficiaries would miss health insurance because of the lack of accountability (Bhattacharya, 2013).
The case study reveals that the health gaps affecting CSHCN are products of two major factors – low levels of health literacy (social impediments to health care access) and poor government policies. Therefore, the solution to reduce health insurance gaps for this population group stems from addressing the causes. For example, improving the health literacy of parents and caregivers would help them to understand the eligibility criteria for different health insurance programs, thereby improving the probability of finding appropriate health insurance plans.
Bhattacharya, D. (2013). Public health policy: Issues, theories, and advocacy. San Francisco, CA: Jossey-Bass.
Hollar, D. (2012). Handbook of Children with Special Health Care Needs. New York, NY: Springer Science & Business Media.
Tudor-Edwards, R., Charles, J. M., & Lloyd-Williams, H. (2013). Public health economics: A systematic review of guidance for the economic evaluation of public health interventions and discussion of key methodological issues. BMC Public Health, 13(1), 1–26.