Factors Associated with Forgone Care Among Children in the United States: An Analysis of the 2016‐2018 National Survey of Children’s Health
Authors: Lichstein J. , Ghandour R. 
Published: August 2020

Delaying or forgoing health care can have negative consequences for the health and well‐being of children. In 2000, Paul Newacheck called for the continued monitoring of unmet health needs among children. While a handful of studies have been conducted since 2000, primarily among children with special healthcare needs (CSHCN), the redesigned National Survey of Children’s Health (NSCH) offers a unique opportunity to examine forgone care among all children ages 0‐17. This study provides the most recent prevalence estimates of forgone care among children in the United States, by type of care, and identifies related sociodemographic and health factors.

We used data from the combined 2016‐2018 NSCH to examine sociodemographic and health factors associated with parent/caregiver‐reported forgone care among children ages 0‐17 years in the United States. We also examined the association of these factors with different types of forgone care and reasons for forgone care. Survey weighted bivariate and logistic regression analyses were conducted.

101,984 children ages 0‐17 years.

3.1% of children (2.2 million) had forgone care in 2016‐2018. Forgone dental care was most frequently reported (1.67%), followed by medical care (1.03%) and mental health care (0.83%). Cost was the most frequently reported reason for forgone care (1.83%), followed by problems getting an appointment (1.20%) and lack of eligibility (0.97%). Children, who were older, had greater number of health conditions, were CSHCN, were Hispanic or non‐Hispanic black, were uninsured, and had family incomes < 100% of the federal poverty level (FPL) were significantly more likely to have any reported forgone care. Among children with forgone care, the factors associated with reporting different types of forgone care varied. After adjustment, insurance status was the only factor consistently associated with all types of care, except hearing services; CSHCN status, number of health conditions, and insurance status were associated with forgone dental care; race/ethnicity and insurance were associated with forgone vision care; age, number of health conditions, CSHCN status, and insurance were associated with forgone mental care; and FPL was associated with forgone hearing services. The factors associated with the different reasons for forgone care also varied. Insurance status and FPL were associated with forgone care due to lack of eligibility and issues with cost; CSHCN status was associated with services not available in the area; and insurance, CSHCN status, and race/ethnicity were associated with problems getting an appointment.

Forgone care remains an issue for over 2.2 million children in the United States. However, the characteristics of children associated with different types of forgone care vary, as do those associated with different reasons for forgoing care. This suggests the need for diverse strategies, in addition to standing efforts to expand insurance coverage, to ensure timely access to needed healthcare services among US children.

Efforts to reduce forgone care will need to address both financial and nonfinancial issues and will need to be tailored to address the factors associated with forgoing different types of care.