Does a Medical Home Mediate Racial Disparities in Unmet Healthcare Needs among Children with Special Healthcare Needs?

OBJECTIVES: This study extends mediation analysis techniques to explore whether and to what extent differential access to a medical home explains the black/white disparity in unmet healthcare needs among children with special healthcare needs (CSHCN). METHODS: Data were obtained from the 2007 National Survey of Children’s Health, with analyses limited to non-Hispanic white and black CSHCN (n=14,677). The counterfactual approach to mediation analysis was used to estimate odds ratios for the natural direct and indirect effects of race on unmet healthcare needs. RESULTS: Overall, 43.0% of white CSHCN and 60.4% of black CSHCN did not have a medical home. Additionally, 8.8% of white CSHCN and 15.3% of black CSHCN had unmet healthcare needs. The natural indirect effect indicates that the odds of unmet needs among black CSHCN are elevated by approximately 20% as a result of their current level of access to the medical home rather than access at a level equal to white CSHCN (ORNIE = 1.2, 95% CI = 1.1, 1.3). The natural direct effect indicates that even if black CSHCN had the same level of access to a medical home as white CSHCN, blacks would still have 60% higher odds of unmet healthcare needs than whites (ORNDE = 1.6, 95% CI =1.1, 2.4). CONCLUSIONS: The racial disparity in unmet healthcare needs among CSHCN is only partially explained by disparities in having a medical home. Ensuring all CSHCN have equal access to a medical home may reduce the racial disparity in unmet needs, but will not completely eliminate it.