Although children with special health care needs comprised less than 16 percent of the child population, they had health care expenditures three times higher than other children, according a UCSF study. Paul W. Newacheck, DrPH., of the UCSF Institute for Health Policy Studies, and colleagues examined health care expenditures of nearly 7,000 children under the age of 18. They identified 949 (15.6 percent) as children with special health care needs (CSHCN), defined as "those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally." From these data the UCSF researchers estimate the number of CSHCN in the US at 11 million. The study appeared in the January issue of The Archives of Pediatrics & Adolescent Medicine. In 2000, CSHCN had an average health care expenditure of $2,099, compared to children without special health care needs who had an average expenditure of $628. CSHCN accounted for 42.1 percent of total medical care costs (excluding dental costs) and 33.6 percent of total health care costs (including dental costs) for children. These children also had more than twice as many physician visits and seven times as many non-physician visits than other children, and had average out-of-pocket costs (for all health care) twice that of other children ($352 vs. $174). Average annual expenditures on prescribed medications were ten times higher ($340 vs. $34) for CSHCN. "Our results show that CSHCN use many more services and have significantly higher health care expenses than other children," writes Newacheck. "Health policy changes that would extend the breadth and depth of insurance coverage are needed to ensure that all families of CSHCN are protected against burdensome expenses."