The 130th Annual Meeting of APHA

Abstract #39225

David B. Rein, MPA, Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, One Park Place South, Suite 660, Atlanta, GA 30303-3083, 404-463-9337, alhdbr@langate.gsu.edu

Background: Health need has historically been defined by the concepts of perceived need (self defined) and evaluated need (physician defined).1 This dichotomy has taken on greater importance as child advocates seek to define boundaries for who are children with special health care needs (CSHCN). Methods: This study used linked claims and survey data to calculate health utilization costs for a random sample of Georgia publicly insured children, stratified by evaluated (defined by 19 health diagnoses found in administrative claims data) and perceived (defined by answers to three screener questions found in the CAHPSâ survey) special health care need. Children were separated into four categories, no perceived or evaluated need, perceived need only, evaluated need only, and perceived and evaluated need. The average yearly costs of each group were estimated. Results: Patients with neither perceived nor evaluated need (62%) had the lowest medical expenditures ($557, se ± 18), followed by those with only a perceived need (9%) ($1108, se ± 95), those with only an evaluated need (16%) ($2447, se ± 153), and finally those with both a perceived and an evaluated need (13%) ($3691, se ± 262). Fully 38% of the sample had either a perceived or evaluated need. Conclusions: This study argues for using both perceived and evaluated need to define CSHCN status, as the two concepts do not appear to measure the same need. Where the measures do overlap, the effect of having both perceived and evaluated need appears additive rather than duplicative.

Learning Objectives: At the conclusion of the session, the participant (learner) will be able to

• Discuss the differences between perceived and evaluated health care need, and understand how each is used to define children with special health care needs.
• Recognize how children identified by measures of perceived and evaluated needs differ in respect to their costs.
• Apply these concepts to survey and claims data used in their policy area.

Keywords: Children With Special Needs, Financing

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: CAHPS Georgia Division of Medical Assistance
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.