We examined key factors that affect out-of-pocket medical expenditures per $1000 of household income for children with special health care needs (CSHCN) with a broad range of conditions, controlling for insurance type and concentrating on the potentially moderating role of the medical home.


A Heckman selection model was used to estimate whether the medical home influenced out-of-pocket medical costs per $1000 of household income for children covered by either private or public health insurance. Data from the 2005–2006 National Survey of CSHCN (N = 31 808) were used.


For families that incurred out-of-pocket medical costs for their CSHCN, these costs represented 2.2% to 3.9% of income. Both insurance type and the medical home had significant effects on out-of-pocket costs. Lower out-of-pocket medical costs per $1000 of income were incurred by children with public insurance and those receiving care coordination services.


Families with CSHCN incur lower out-of-pocket medical costs when their children receive health care in a setting in which the care-coordination component of the medical home is in place.

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