The study sample was sourced from a national claims database of over 8.7 million people ages zero to 18:
- Individuals with no chronic disease: 6,399,006
- Individuals with non-complex chronic diseases: 1,674,450
- Individuals with complex chronic diseases: 603,237
Four key takeaways from the study:
- Children with non-complex chronic diseases were more likely to encounter out-of-network care compared to those with no chronic disease by about 6.8 percentage points, with about 14 percent receiving out-of-network care compared to about 7 percent of children with no chronic disease.
- Children with non-complex chronic diseases’ cost-sharing payments for out-of-network care were $288 higher than those with no chronic disease.
- Children with complex chronic diseases were more likely to encounter out-of-network care compared to those with no chronic disease by about 16.1 percentage points, with around 24 percent receiving out-of-network care.
- Children with complex chronic diseases cost-sharing payments for out-of-network care were $599 higher than those with no chronic disease.
“In the U.S., the reality is that the more health care needs you have, especially from specialists, the greater chance you will find your needs won’t be met, even if you have private insurance coverage,” study author Wendy Xu, PhD, told Ohio State News. “Inadequate provider networks can really constrain their access to care and it’s an ongoing struggle. These are conditions that will never go away and are pretty severe, and these patients very often face additional care needs because of mental health conditions.”
