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:

1. Hagan, J. F., Shaw, J. S., & Duncan, P. M. (Eds.). (2008). Bright futures: Guidelines for health supervision of infants, children, and adolescents (3^rd ed.). Elk Grove Village, IL: American Academy of Pediatrics. Retrieved from: http://brightfutures.aap.org/pdfs/Guidelines_PDF/1-BF-Introduction.pdf
2. 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
3. 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
4. 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/
5. 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:

1. 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/
2. 100% Campaign. (2010). Why coverage is important. Retrieved from: http://sites.activatedirect.com/100percentcampaign.org/coverage/?_c=xxd8fb5l61pyn7
3. 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
4. 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
5. 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
6. 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
7. 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/
8. 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
9. 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 
10. 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
11. 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.

• California HealthCare Foundation
• California School Health Centers Association
• Child and Adolescent Health, Agency for Healthcare Research and Quality
• Child Health USA, U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau
• Family Health Outcomes Project, UCSF
• Health Affairs
• Health Insurance and Access to Care Knowledge Path, Maternal and Child Health Library at Georgetown University
• Mathematica Policy Research: Medicaid and The Children’s Health Insurance Program
• National Academy for State Health Policy (NASHP)
• National Center for Medical Home Implementation, Maternal and Child Health Bureau & American Academy of Pediatrics
• Prevention Institute
• Robert Wood Johnson Foundation Commission to Build a Healthier America
• Social Determinants of Health, Centers for Disease Control and Prevention
• The Center for Health and Health Care in Schools
• The Children's Partnership: Children's Health Care/Health Reform
• The Commonwealth Fund
• UCLA Center for Health Policy Research

• America’s Future: Latino Child Well-Being in Numbers and Trends, 2010, National Council of La Raza & Population Reference Bureau
• Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents (Third Edition), 2008, American Academy of Pediatrics, Hagan et al., eds.
• Child Health Research: Identifying Quality Problems and Improving Care, 2010, Agency for Healthcare Research and Quality
• Covering Kids: Children's Health Insurance in California, 11/2012, California HealthCare Foundation
• Health at School: A Hidden Health Care System Emerges from the Shadows, 2007, Health Affairs, Graham-Lear
• Including Safety-Net Providers in Integrated Delivery Systems: Issues and Options for Policymakers, 08/2012, The Commonwealth Fund & The National Academy for State Health Policy, Witgert & Hess
• Investing in Children’s Health: What are the Economic Benefits?, 10/2005, World Health Organization, Belli, Bustreo & Preker
• Kids Share 2012: Report on Federal Expenditures on Children Through 2011, 07/2012, Urban Institute, Isaacs, et al.
• Lasting Returns: Investing in Health Coverage for California's Children, 02/2005, The California Budget Project
• Pediatric Medical Homes: Laying the Foundation of a Promising Model of Care, 10/2011, National Center for Children in Poverty, Bachrach et al.
• Racial and Ethnic Disparities in the Health and Health Care of Children, 04/2010, Pediatrics, Flores
• Recommendations to Improve Preconception Health and Health Care --- United States, 04/21/2006, Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Johnson et al.
• School-Based Health Centers: National Census School Year 2007-2008, 2009, National Assembly on School-Based Health Care
• Securing a Healthy Future: The Commonwealth Fund State Scorecard on Child Health System Performance, 2011, The Commonwealth Fund, How et al.
• Systems of Care Coordination for Children: Lessons Learned Across State Models, 09/2010, The Commonwealth Fund, Silow-Carroll & Hagelow
• The Language Spoken at Home and Disparities in Medical and Dental Health, Access to Care, and Use of Services in U.S. Children, 06/02/2008, Pediatrics, Flores & Tomany-Korman
• The Role of Children's Coverage Programs in a Changing Health Care Landscape: EPSDT, CHIP, and Health Care Reform, 07/2011, National Academy for State Health Policy, Farrell & Hess
• The Role of Health Insurance Coverage in Reducing Racial/Ethnic Disparities in Health Care, 2005, Health Affairs, Lillie-Blanton & Hoffman
• Transforming The U.S. Child Health System, 2007, Health Affairs, Halfon, DuPlessis & Inkelas
• Unclaimed Children Revisited: California Case Study, 04/2010, National Center for Children in Poverty, Cooper et al.
• Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, 2002, Institute of Medicine of the National Academies
• Uninsured Children 2009-2011: Charting the Nation’s Progress, 10/2012, Georgetown University Health Policy Institute Center for Children & Families, Alker, Mancini & Heberlein
• Uninsured Children: Who Are They and Where Do They Live, 09/2010, Robert Wood Johnson Commission to Build a Healthier America, Lynch et al.

• Expanding Coverage for Children: Santa Clara County's Children's Health Initiative, Mathematica Policy Research Inc.
• Final Report of the Evaluation of the San Mateo County Children's Health Initiative, 05/2008, Urban Institute, Howell et al.
• How Policy Changes Impact Enrollment: A Look at Three Counties, 2004, California HealthCare Foundation, The Lewin Group
• San Diego County Report Card on Children & Families, 2011, The Children's Initiative and Johnson Group Consulting, Inc.
• San Francisco Bay Area Asian American, Native Hawaiian and Pacific Islander Youth Health Status Report, 12/2007, Asian and Pacific Islander Bay Area Health Council, Asian and Pacific Islander Health Forum
• Santa Barbara County Children's Scorecard, 2010, Santa Barbara County KIDS Network
• Santa Clara County Children’s Agenda: Indicators of Child Health and Well-Being (Data Book), 2012, Kids in Common
• Tulare County Children’s Report Card 2010, 2011, Children's Services Network

add your report to kidsdata.org

Do you have a local or regional report relevant to a topic on kidsdata.org? If you’d like to add it to our research and links section, please send it to us at kidsdata@lpfch.org.