PORTLAND, Ore. — The first federally funded report to compare children with special health care needs to children without reveals 14 percent to 19 percent of children in the United States have a special health care need and their insurance is inadequate to cover the greater scope of care they require for optimal health.

The report, Children with Special Health Care Needs in Context: A Portrait of States and the Nation 2007, provides an enhanced view of children by illustrating their health, health care, home and family environments, and school and neighborhood environments compared with their peers without special health care needs. It is based on findings from the 2007 National Survey of Children's Health (NSCH) sponsored by the Health Resources and Services Administration's Maternal and Child Health Bureau.

In the survey, children with special health care needs are defined as those who have one or more chronic physical, developmental, behavioral, or emotional conditions for which they require a type or amount of health and related services that is above routine-level care.

The key findings in the report demonstrate critical differences between these groups. While more than 88 percent of children ages 0 to 17 with special health care needs have consistent health insurance coverage, it is less likely to meet their greater health care needs compared with children without special health care needs. The percentage of children with special health care needs who have inadequate health insurance ranges from 20 percent to 38 percent across states.

"The NSCH is a valuable information source that can be used to inform efforts to advance the health of our nation's children. It allows us to measure children's health, well-being and health care system performance in the context of their family, home, community and school environments — and to compare across many subgroups of children within and across states," said Christina Bethell, Ph.D., M.B.A., M.P.H., director of the Child and Adolescent Health Measurement Initiative (CAHMI) and a professor of pediatrics in the Oregon Health & Science University School of Medicine, OHSU Doernbecher Children's Hospital.

"This information is important to identify priorities and opportunities for improving children's health and health care in the United States. The CAHMI Data Resource Center for Child and Adolescent Health is committed to making this information readily available to the public on our user-friendly website," said Bethell.

Additional key survey findings include:

• Children with special health care needs are more likely to be overweight or obese compared to children without special health care needs.
• Children with special health care needs are less likely to be engaged in school and are more likely to have repeated one or more grades compared to their peers without special health care needs.
• Just over one-third (36 percent) of children with special health care needs meet criteria minimum threshold for receiving quality care, which is characterized by having a medical home, adequate health insurance and having at least one preventive visit in the past year.
• Only 23 percent of children with special health care needs live in protective home environments compared to 30 percent of children without special health care needs. A protective home environment includes factors such as eating meals together, limited television watching and whether or not a child is exposed to secondhand tobacco smoke in the home.
• Children with and without special health care needs are similarly likely to live in safe and supportive neighborhoods.