Kidsdata.org includes the following health care measures:
- The percentage of children ages 0-17 with and without health insurance, and by type of coverage
- The percentage of children ages 0-17 who did not receive needed health care or whose care was delayed during the past 12 months, and the percentage without reported problems getting care
- The percentage of youth ages 12-17 by length of time since their last routine health check-up
- The percentage of children ages 0-17 who have a medical home, and by age, income level, and race/ethnicity (for California and the U.S. only)
- The number of school-based or school-linked health centers serving public schools
- Parent ratings of the quality of their child's health care, and by income level (for California, Los
Angeles County, and the Bay Area only)
- Parent ratings of their child's overall physical health, and by income level (for California, Los
Angeles County, and the Bay Area only)
For many families, health insurance is provided by an employer. State
programs such as Medi-Cal and Healthy Families also are available for
eligible low-income families, although undocumented immigrants generally
are excluded from these programs. Some counties have Children's Health
Initiatives, which help provide coverage for low-income children who are
ineligible for state programs, including those who are undocumented.
The American Academy of Pediatrics describes the medical home as a model of delivering primary care that is "accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective." For more information on the medical home model see http://www.medicalhomeinfo.org/
According to the American Academy of Pediatrics, every child should receive high quality, coordinated, comprehensive, and preventive health care (1). This care is best offered through a “medical home,” an ongoing family-centered partnership with a child health professional or team, in which all of the patient’s needs are met (1). Children who receive care in the context of a medical home are more like to have annual, preventive check-ups (which can lead to the early identification and treatment of problems) and are less likely to have unmet medical and dental needs (2). In 2009, 6% of U.S. children lacked a usual source of health care (3). Not surprisingly, children with health insurance are far more likely to have a usual source of care than uninsured children. Approximately 7.5 million U.S. children (10% of all kids) were uninsured in 2009 (3).
One convenient way for children and youth to access needed health services is through school-based health centers. Nearly 2,000 centers currently operate nationwide (4). These health centers, whether located on school property or in the vicinity of a school, offer a range of services to underserved or uninsured students, including primary medical care, behavioral health, dental care, substance abuse counseling, and nutrition education (4). Research has found that school-based health centers can lead to improved health care access, increased school attendance, and reduced inappropriate emergency room visits among youth (5).
For more information on health care, see kidsdata.org’s Research & Links section.
Sources for this narrative:
- Hagan, J. F., Shaw, J. S., & Duncan, P. M. (Eds.). (2008). Bright futures: Guidelines for health supervision of infants, children, and adolescents (3rd ed.). Elk Grove Village, IL: American Academy of Pediatrics. Retrieved from: http://brightfutures.aap.org/pdfs/Guidelines_PDF/1-BF-Introduction.pdf
- Strickland, B. B., Jones, J. R., Ghandour, R. M., Kogan, M. D., & Newacheck, P. W. (2011). The medical home: Health care access and impact for children and youth in the United States. Pediatrics, 127(4), 604-611. Retrieved from: http://pediatrics.aappublications.org/content/early/2011/03/14/peds.2009-3555
- Federal Interagency Forum on Child and Family Statistics. (2011). Health care. America’s children: Key national indicators of well-being, 2011. Washington, DC: U.S. Government Printing Office. Retrieved from: http://www.childstats.gov/americaschildren/care.asp
- U.S. Department of Health and Human Services, Health Resources and Services Administration. (2011). School-based health centers. Retrieved from: http://www.hrsa.gov/ourstories/schoolhealthcenters/
- National Association on School-Based Health Care. (n.d.) Benefits of school based health care: Fact sheet. Retrieved from: http://www.nasbhc.org/site/c.ckLQKbOVLkK6E/b.7526255/k.9AF9/SBHC_Fact_Sheets.htm
Providing quality, accessible, and affordable health care to children requires comprehensive insurance coverage for all children; an appropriately trained and compensated provider base; parental understanding about what care is needed and how to access it; and effective systems of care, including a “medical home.” When children have health insurance, they are more likely to receive preventive care and acute care, miss less school, and their families are at less financial risk from unpaid medical bills (1, 2). Immigrant children, especially those with undocumented parents or those who are themselves undocumented, are at particular risk of being uninsured and without regular health care (3).
According to research and subject experts, policy options that could improve children’s health care include:
- Maintaining continuous Healthy Families and Healthy Kids insurance
coverage for all eligible children, including immigrant children (1, 2,
3)
- Ensuring that every child has access to family-centered, culturally competent and coordinated care within a medical home, particularly children with special health care needs (4, 5, 6)
- Ensuring that training is provided to general pediatricians on medical home implementation and management of care for children with special health care needs; and ensuring that there is an adequate number of trained pediatric specialty care providers (6, 7)
- Adopting, funding, and supporting effective use of efficient application and enrollment processes, such as web-based systems that provide a one-stop approach to enrollment in various public and private health, social service, and other programs (8, 9)
- Ensuring that public insurance reimbursement for pediatric visits covers the time required to focus on child/youth development, family-centered care and – for youth – sexual and reproductive health (2, 5, 10, 11)
- Expanding access to health education and consultation services for parents/guardians and service providers in the range of programs that serve young children, including child care settings, nutrition programs, and foster care homes (5)
For more policy ideas and research on this topic see Research & Links on this page or visit the California HealthCare Foundation, the 100% Campaign, the National Center for Medical Home Implementation, and the American Academy of Pediatrics. Also see Policy Implications on kidsdata.org under Prenatal Care and Dental Care.
Sources for this narrative:
- Galbraith, A. A., Wong, S. T., Kim, S. E., & Newacheck, P. W. (2005). Out-of-pocket financial burden for low-income families with children: Socioeconomic disparities and effects of insurance. Health Services Research, 40(6 Pt. 1), 1722-1736. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361224/
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100% Campaign. (2010). Why coverage is important. Retrieved from: http://sites.activatedirect.com/100percentcampaign.org/coverage/?_c=xxd8fb5l61pyn7
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Artiga, S., & Schwartz, K. (2007). Health insurance coverage and access to care for low-income non-citizen children. Kaiser Commission on Medicaid and the Uninsured. Retrieved from: http://www.kff.org/medicaid/7643.cfm
- American Academy of Pediatrics.
(2002). Policy statement: The medical home. Pediatrics, 110(1), 184-186. Retrieved from: http://pediatrics.aappublications.org/content/110/1/184.full?sid=25cb6a37-1d6b-496e-b4ad-a456ffb80ab4
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Zero to Three. (2009). Ensuring good physical health of our infants and toddlers. Retrieved from: http://main.zerotothree.org/site/DocServer/HealthSinglesMar5.pdf?docID=7888
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National Center for Medical Home Implementation. (2011). Educating medical students and residents on medical home. American Academy of Pediatrics. Retrieved from: http://www.medicalhomeinfo.org/training/residency.aspx
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Lucile Packard Foundation for Children’s Health. (2010). Children with special health care needs: A profile of key issues in California. Retrieved from: http://www.lpfch.org/specialneeds/
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Ange, E., Chimento, L., Park, C., & Wilk, A. (2008). Assessment of one-e-App: A web-based application and enrollment application for public health insurance programs. The Lewin Group for the California Endowment and the California HealthCare Foundation. Retrieved from: http://www.lewin.com/~/media/lewin/site_sections/publications/oneeappfinalrpt.pdf
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Ange, E., Chimento, L., Park, C., & Wilk, A. (2009). Using web technology for public program enrollment: Assessing one-e-app in three California counties. The Lewin Group for the California HealthCare Foundation. Retrieved from: http://www.chcf.org/publications/2009/06/using-web-technology-for-public-program-enrollment-assessing-oneeapp-in-three-california-counties
- Gold, R. B. (2009). Unintended consequences: How insurance processes inadvertently abrogate patient confidentiality. Guttmacher Policy Review, 12(4). Retrieved from: http://www.guttmacher.org/pubs/gpr/12/4/gpr120412.html
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Goldenring, J., & Rosen, D. S. (2004). Getting into adolescent heads: An essential update. Contemporary Pediatrics, 21(1), 64-90. Retrieved from:
http://www.aap.org/pubserv/PSVpreview/pages/Files/HEADSS.pdf
In 2009, an estimated 95% of California children ages 0-17 had health insurance, an increase from about 91% in 2001. Roughly half of children (53%) received health care coverage through employment-based insurance in 2009, and about 38% of children had public insurance, such as Medi-Cal or Healthy Families. Health care coverage varies by county, with figures ranging from about 87% to nearly 100% of children insured in 2009.
The percentage of California children who did not receive needed health care or whose care was delayed at least one year was about 5% in 2009. At the county/regional level, the percentage of children with delayed or no health care ranged from approximately 2-15%.
Among youth ages 12-17, 86% received a routine health check-up within the past 12 months in 2009, up from an estimated 77% in 2001. However, only about 50% of California children ages 0-17 had access to a “medical home,” compared to 58% nationwide, according to the most recent data (2007). Overall, older, low-income, Latino/Hispanic, and African American/Black children and youth were less likely to have a medical home.
School health centers provide access to health care for many children.
In 2012, there were 200 school health centers serving California public schools, up from 153 in 2009. However, school health
centers are not dispersed equally across the state. In fact, in 2012, a majority of counties (32 of 58) had zero school health centers, and Los Angeles County alone
had one-third of all health centers in the state.
A 2010 survey of California parents found that most children are in good or excellent physical health (93%) and have good/excellent health care (90%). However, children from low-income households are more likely to be in poor/fair health and receive poor/fair health care, according to parents.