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- Definition: Percentage of children ages 0-17 who receive coordinated, ongoing, comprehensive care that meets American Academy of Pediatrics 'medical home' standards, by household income level. (E.g., in 2011-2012, 24.5% of California children living below the federal poverty threshold (0-99% of Federal Poverty Level (FPL)) received care within a medical home. The FPL was $23,283 for a family of two adults and two children in 2012.)
- Data Source: Child and Adolescent Health Measurement Initiative, Data Resource Center for Child and Adolescent Health, Advancing data-in-action partnerships for children and children with special health care needs in California counties and cities using synthetic estimation from the 2011/12 National Survey of Children’s Health and 2008-2012 American Community Survey (Jun. 2016).
- Footnote: The American Academy of Pediatrics defines a medical home as a model of delivering primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. For more information, see www.medicalhomeinfo.org. Five of the seven components of a medical home and the presence of a personal doctor or nurse are assessed by the National Survey of Children with Special Health Care Needs. To qualify as having a medical home, a child must have a personal doctor or nurse and meet the criteria for adequate care on every needed component. 2011-2012 data for cities and counties with at least 70,000 residents are synthetic estimates based on 2008-2012 population data. 2007 estimates are not available for counties or cities. Some regions listed are Census Designated Places (CDPs), such as East Los Angeles; CDPs are communities within the unincorporated part of a county. N/A means that data are not available.
- Measures of Health Care on Kidsdata.org
Kidsdata.org includes the following health care measures:
*Medi-Cal is California's Medicaid program and is available for eligible low-income children and families.
- The percentage of children ages 0-17 who did not receive needed health care or whose care was delayed during the past 12 months
- The percentage of children ages 0-17 with and without health insurance, by age and type of insurance, by race/ethnicity, by legislative district, and by legislative district and race/ethnicity (see the list of indicators)
- The percentage of youth ages 12-17 reporting the length of time since their last routine health check-up
- The usual source of health care for children ages 0-17, by income level and race/ethnicity
- Annual Medi-Cal enrollment for youth ages 0-21 by county as a number or rate and, at the state-level only, average monthly enrollment by age as a number or rate and by race/ethnicity as a number or rate*
- The percentage of children ages 0-17 who receive care within a medical home, by age, by income level, and by race/ethnicity**
- School staff reports on the extent to which they believe their school provides adequate health services for students
- The number of school-based or -linked health centers serving public schools
- The percentage of children ages 0-17 uninsured at any point in the last year
- The percentage of children ages 0-17 who visited the emergency room in the last year, by type of insurance
**According to the American Academy of Pediatrics, a medical home is a model of delivering primary care that is “accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.” For more information, see www.medicalhomeinfo.org.
- Health Care
- Delayed or No Medical Care
- Length of Time Since Last Routine Health Check-Up
- Visited the Emergency Room in Last Year, by Type of Insurance
- Uninsured at Any Point in Last Year
- Health Insurance Coverage (Regions of 65,000 Residents or More), by Type of Insurance and Age
- Health Insurance Coverage (Regions of 10,000 Residents or More), by Type of Insurance and Age
- Medi-Cal Enrollment
- Receipt of Care Within a Medical Home (Regions of 70,000 Residents or More)
- Adequate Health Services Provided at School (Staff Reported)
- School Health Centers
- Characteristics of Children with Special Needs
- Insured/Uninsured Children Who Have Major Disabilities, by City, School District and County (Regions of 65,000 Residents or More)
- Insured/Uninsured Children Who Have Special Health Care Needs, by Type of Insurance (California & U.S. Only)
- Access to Services for Children with Special Health Care Needs
- Children with Special Health Care Needs Who Need Five or More Services (California & U.S. Only)
- Children with Special Health Care Needs Who Had a Preventive Medical Visit in the Last Year (California & U.S. Only)
- Difficulty Accessing Community-Based Services for Children with Special Health Care Needs (California & U.S. Only)
- Early Intervention for Children with Special Health Care Needs (California & U.S. Only)
- Receipt of Mental Health Services Among Children with Special Health Care Needs Who Need Treatment or Counseling (California & U.S. Only)
- Referrals to Specialty Care for Children with Special Health Care Needs (California & U.S. Only)
- Unmet Needs for Health Services Among Children with Special Health Care Needs (California & U.S. Only)
- Unmet Needs for Preventive Dental Services Among Children with Special Health Care Needs (California & U.S. Only)
- Usual Source of Health Care Among Children with Special Health Care Needs (California & U.S. Only)
- Youth with Special Health Care Needs Who Receive Needed Services for the Transition to Adulthood (California & U.S. Only)
- Insurance Coverage for Children with Special Health Care Needs
- Insurance Coverage for Children with Special Health Care Needs, by Insurance Status (California & Other States Only)
- Consistency of Insurance Coverage, by Special Needs Status (California & U.S. Only)
- Adequacy of Insurance Coverage Among Insured Children, by Special Needs Status (California & U.S. Only)
- Quality of Care for Children with Special Health Care Needs
- Children with Special Health Care Needs Who Receive Care that Meets Federal Minimum Quality Standards (California & U.S. Only)
- Receipt of Family-Centered Health Care for Children with Special Health Care Needs (California & U.S. Only)
- Receipt of Care Within a Medical Home for Children with Special Health Care Needs (California & U.S. Only)
- Dental Care
- Pupil Support Service Personnel
- Prenatal Care
- Teen Sexual Health
- Why This Topic Is Important
According to the American Academy of Pediatrics, every child should receive high quality health care that is accessible, family-centered, culturally competent, coordinated, continuous, compassionate, and comprehensive (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 likely 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 (1). However, according to 2011-12 estimates, 54% of U.S. children—and only 45% of California kids—received care within a medical home (2). Not surprisingly, children without health insurance are less likely to access needed care than children with insurance (3). Estimates from a 2015 survey show that 8% of U.S. children were uninsured for at least part of the preceding year (4).One convenient way for children and youth to access needed services is through school-based health centers (SBHCs). These centers, whether located on school property or in the vicinity of a school, offer a range of services to underserved or uninsured students, such as primary medical care, mental or behavioral health care, dental care, substance abuse services, and health and nutrition education. Nearly 2,000 SBHCs operate nationwide (5). These centers have become a key part of the health care delivery system, as children and youth spend a significant amount of time at school, and barriers such as transportation and scheduling are reduced. Research has found that SBHCs can lead to improved access to medical and dental care, health outcomes, and school performance (5, 6). They also have been shown to reduce emergency room visits and health care costs (5, 6).
For more information on health care, see kidsdata.org’s Research & Links section.
Sources for this narrative:
1. Strickland, B. B., et al. (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/127/4/604
2. As cited on kidsdata.org, Medical home access (regions of 70,000 residents or more). (2016). Child and Adolescent Health Measurement Initiative, Data Resource Center for Child and Adolescent Health.
3. Alker, J., & Chester, A. (2014). Children's coverage at a crossroads: Progress slows. Georgetown University Center for Children and Families. Retrieved from: http://ccf.georgetown.edu/ccf-resources/childrens-coverage-crossroads-progress-slows
4. Cohen, R. A., et al. (2016). Health insurance coverage: Early release of estimates from the National Health Interview Survey, 2015. National Center for Health Statistics. Retrieved from: http://www.cdc.gov/nchs/nhis/releases/released201605.htm
5. American Academy of Pediatrics, Council on School Health. (2012). School-based health centers and pediatric practice. Pediatrics, 129(2), 387-393. Retrieved from: http://pediatrics.aappublications.org/content/129/2/387
6. U.S. Department of Health & Human Services, Community Preventive Services Task Force. (2015). Promoting health equity through education programs and policies: School-Based Health Centers. Retrieved from: http://www.thecommunityguide.org/healthequity/education/RRschoolbasedhealthcenters.html
- How Children Are Faring
An estimated 97% of California children under age 18 had health insurance in 2015—up from 91% in 2009—yet gaps remain. For example, among racial/ethnic groups in California, 2015 estimates of children without insurance were 8% for American Indians/Alaska Natives, compared to 4% or less for all other groups with data.
In 2013, nearly 4 million children and youth ages 0-21 in California were enrolled in the Medi-Cal program: 347 per 1,000. The number and rate of enrollees decreased slightly in 2013, after increasing between 2007 and 2012. Enrollment rates are highest among infants and lowest among young adults ages 19-21. African American/black children/youth have the highest enrollment rates (578 per 1,000 in 2013) among racial/ethnic groups with data.
Among California youth ages 12-17, an estimated 88% received a routine health check-up within the past 12 months in 2013-2014, up from about 77% in 2001. However, 2011-2012 data show that fewer than half (45%) of the state's children under age 18 receive care within a “medical home,” compared to 54% nationwide. In California counties with data, estimates of children receiving care within a medical home ranged from 37% (Imperial County) to 59% (Marin County) in 2011-2012. In California and the U.S., estimates of care within a medical home are lowest for older, low-income, Hispanic/Latino, and African American/black children.According to 2013-2014 data, California children were most likely to use a doctor’s office or HMO as their usual source of health care (63%). For children living below 200% of the Federal Poverty Level this estimate was 48%, compared to 77% percent among children from higher-income families. Over 7% of California children were estimated to have no usual source of health care in 2013-2014; among racial ethnic groups with data, estimates ranged from 5% (multiracial and white) to 11% (African American/black).
School health centers provide access to health care for many children. In 2016, California had 243 school health centers, up from 153 in 2009. However, more than half of the state's counties (31 of 58) did not have any school health centers in 2016.
In 2011-2013, 57% of public school staff in California reported that they “agreed” or “strongly agreed” that their school provides students with adequate health services. Elementary school staff reported the highest percentage of agreement that their school provides adequate health services; non-traditional and K-12 school staff reported the lowest.
- Policy Implications
Children with health insurance are more likely to receive needed medical care and perform well in school, and they are less likely to have costly hospitalizations (1). Providing quality, accessible, and affordable health care to children requires comprehensive insurance coverage for all children, an appropriately trained and compensated provider base including a sufficient number of subspecialists, parental understanding about what care is needed and how to obtain it, and effective systems of care including “medical homes” (2, 3, 4). 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 (5, 6).
The 2010 Affordable Care Act (ACA), which expanded health care coverage and enacted other major health system changes, has the potential to greatly increase the number of insured children in the nation. While gains have been made, data indicate that progress has slowed in recent years, and an estimated 4.5% of U.S. children and 3.6% of California children remained uninsured in 2015 (7). Continued, effective implementation of the ACA, including efforts to streamline enrollment and renewal processes, will influence progress in future years (8).
Policy options that could improve children’s health care include:
For more policy ideas and research on this topic, see kidsdata.org's Research & Links section or visit the California HealthCare Foundation, the National Academy for State Health Policy, and the American Academy of Pediatrics.
- Supporting efforts to ensure continuous insurance coverage for all low-income children, including immigrant children (2, 5, 6, 8)
- Ensuring that every child has access to family-centered, culturally competent, and coordinated care within a medical home, particularly children with chronic conditions (3, 9)
- Expanding access to health consultation or education for parents/guardians and service providers in programs serving young children, such as child care settings, home-visiting programs, and foster care homes (10)
- Ensuring that there is an adequate number of pediatric specialty care providers and that pediatricians are trained on management of care for children with special health care needs, medical home implementation, and culturally effective pediatric practice (3, 4)
- Monitoring the capacity and financial viability of safety-net providers, such as county hospitals, which are important sources of care for low-income people who have gained coverage through Medi-Cal (California's Medicaid program) and Covered California, the state's insurance marketplace under the ACA (11)
- Ensuring that public insurance reimbursement for pediatric visits covers the time required to focus on child/youth development and family-centered care (4, 10)
- Supporting collaboration across the health, education, social, and economic sectors to improve prevention, early intervention, and treatment services for children, recognizing that societal factors strongly influence health and that child health problems can have lifelong effects; such efforts could improve population health outcomes and health inequities, as well as lower costs associated with preventable conditions (12)
Sources for this narrative:
1. Children’s Defense Fund-California. (n.d.). Children’s health. Retrieved from: http://www.cdfca.org/policy/health
2. The Children’s Partnership. (2016). The Affordable Care Act and children’s coverage in California: Our progress and our future. Retrieved from: http://www.childrenspartnership.org/research-list/the-affordable-care-act-and-childrens-coverage-in-california-our-progress-and-our-future
3. Strickland, B. B., et al. (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/127/4/604
4. American Academy of Pediatrics, Committee on Pediatric Workforce. (2013). Pediatrician workforce policy statement. Pediatrics, 132(2), 390-397. Retrieved from: http://pediatrics.aappublications.org/content/132/2/390
5. Hamilton, E. R., & Evans, E. (n.d.). State health insurance policy and insuring immigrant children. UC Davis Center for Poverty Research. Retrieved from: http://poverty.ucdavis.edu/research-paper/policy-brief-state-health-insurance-policy-and-insuring-immigrant-children
6. American Academy of Pediatrics, Council on Community Pediatrics. (2013). Providing care for immigrant, migrant, and border children. Pediatrics, 131(6), e2028-e2034. Retrieved from: http://pediatrics.aappublications.org/content/131/6/e2028
7. Cohen, R. A., et al. (2016). Health insurance coverage: Early release of estimates from the National Health Interview Survey, 2015. National Center for Health Statistics. Retrieved from: http://www.cdc.gov/nchs/nhis/releases/released201605.htm
8. Alker, J., & Chester, A. (2014). Children's coverage at a crossroads: Progress slows. Georgetown University Center for Children and Families. Retrieved from: http://ccf.georgetown.edu/ccf-resources/childrens-coverage-crossroads-progress-slows
9. Coller, R. J., et al. (2015). The medical home and hospital readmissions. Pediatrics, 136(6), e1550-e1560. Retrieved from: http://pediatrics.aappublications.org/content/136/6/e1550
10. Kossen, J., & Rosman, E. (2012). Leading the way to a strong beginning: Ensuring good physical health of our infants and toddlers. Zero to Three. Retrieved from: https://www.zerotothree.org/resources/996-leading-the-way-to-a-strong-beginning-ensuring-good-physical-health-of-our-infants-and-toddlers
11. McConville, S. (2016). California's future: Health care. Public Policy Institute of California. Retrieved from: http://www.ppic.org/main/publication.asp?i=1020
12. Halfon, N., et al. (2014). The changing nature of children’s health development: New challenges require major policy solutions. Health Affairs, 33(12), 2116-2124. Retrieved from: http://content.healthaffairs.org/content/33/12/2116.full
- Websites with Related Information
- California Coverage & Health Initiatives
- California Health Care Foundation
- California School-Based Health Alliance
- Center for Children and Families, Georgetown University Health Policy Institute
- Center for Health and Health Care in Schools, George Washington University
- Family Health Outcomes Project, University of California, San Francisco
- Health Affairs
- Health Insurance and Access to Care for Children and Adolescents Knowledge Path, National Center for Education in Maternal and Child Health
- National Academy for State Health Policy (NASHP)
- National Center for Medical Home Implementation, American Academy of Pediatrics
- Prevention Institute
- Robert Wood Johnson Foundation
- Social Determinants of Health: Know What Affects Health, Centers for Disease Control and Prevention
- The Children's Partnership: Health Care
- The Commonwealth Fund
- UCLA Center for Health Policy Research
- Key Reports
- "We Ain't Crazy! Just Coping With a Crazy System" Pathways into the Black Population for Eliminating Mental Health Disparities, 2012, California Dept. of Mental Health, Woods, V. D., et al. (Eds.)
- A New Pediatrics for a New Century, 2013, Pediatrics, Lantos, J. D., & Ward, N. A.
- Aiming Higher: Results from a Scorecard on State Health System Performance, 2014, The Commonwealth Fund, Radley, D. C., et al.
- Asian Pacific Islander (API) Population Report: In Our Own Words, 2013, California Dept. of Public Health, Office Of Health Equity
- California and Its Counties Under the ACA: A Leadership Framework, 2014, California Health Care Foundation, Kelch, D. R.
- Caring for Children, 2014, Health Affairs, Weil, A. R.
- Children’s Coverage at a Crossroads: Progress Slows, 2014, Georgetown University Center for Children and Families, Alker, J., & Chester, A.
- Children’s Health Insurance Program (CHIP): Accomplishments, Challenges, and Policy Recommendations, 2014, Pediatrics, American Academy of Pediatrics Committee on Child Health Financing
- Children’s Health Programs in California: Promoting a Lifetime of Health and Well-Being, 2015, California Budget & Policy Center, Schumacher, K.
- Community-Defined Solutions for Latino Mental Health Care Disparities, 2012, UC Davis Center for Reducing Health Disparities, Aguilar-Gaxiola, S., et al.
- Enhancing Pediatric Workforce Diversity and Providing Culturally Effective Pediatric Care: Implications for Practice, Education, and Policy Making, 2013, Pediatrics, American Academy of Pediatrics Committee on Pediatric Workforce
- Enrollment in Health and Nutrition Safety Net Programs Among California's Children, 2015, Public Policy Institute of California, Beck, L., et al.
- First, Do No Harm: Reducing Disparities for Lesbian, Gay, Bisexual, Transgender, Queer and Questioning Populations in California, 2012, California Dept. of Public Health, Office of Health Equity, Mikalson, P., et al.
- Health Equity: School-Based Health Centers, 2015, The Community Guide, Community Preventive Services Task Force
- Native Vision: A Focus on Improving Behavioral Health Wellness for California Native Americans, 2012, California Dept. of Mental Health and California Reducing Disparties Project
- Patient- and Family-Centered Care Coordination: A Framework for Integrating Care for Children and Youth Across Multiple Systems, 2014, Pediatrics, American Academy of Pediatrics Council on Children with Disabilities and Medical Home Implementation Project Advisory Committee
- Policies to Promote Child Health, 2015, The Future of Children, 25(1)
- Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity, 2015, California Dept. of Public Health, Office of Health Equity
- Providing Care for Immigrant, Migrant, and Border Children, 2013, Pediatrics, American Academy of Pediatrics Council on Community Pediatrics
- Racial and Ethnic Disparities in the Health and Health Care of Children, 2010, Pediatrics, Flores, G., & American Academy of Pediatrics Committee on Pediatric Research
- School-Based Health Centers and Pediatric Practice, 2012, Pediatrics, American Academy of Pediatrics Council on School Health
- The Affordable Care Act and Children’s Coverage in California: Our Progress and Our Future, 2016, The Children's Partnership, Schneider, L., et al.
- The Changing Nature of Children’s Health Development: New Challenges Require Major Policy Solutions, 2014, Health Affairs, Halfon, N., et al.
- The Patient-Centered Medical Home, Electronic Health Records, and Quality of Care, 2014, Annals of Internal Medicine, Kern, L. M., et al.
- County/Regional Reports
- 2014 Solano Children's Report Card, Children's Network of Solano County
- Children's Report Card, Sacramento County Children's Coalition
- Community Health Assessment 2015, Los Angeles County Dept. of Public Health
- Fresno Community Scorecard
- Los Angeles: Thriving or Surviving in a Fragmented Market, 2016, California Health Care Foundation, Felland, L., et al.
- Orange County Community Indicators Report, 2016, Orange County Community Indicators Project
- San Diego County Report Card on Children and Families, 2015, The Children's Initiative & Live Well San Diego
- Santa Clara County Children's Agenda: 2016 Data Book, Planned Parenthood & Kids in Common
- The 22nd Annual Report on the Conditions of Children in Orange County, 2016, Orange County Children's Partnership
- More Data Sources For Health Care
- 2016 KIDS COUNT Data Book, Annie E. Casey Foundation
- 2016-17 California County Scorecard of Children's Well-Being, Children Now
- ACA 411, California Health Care Foundation
- California Health and Human Services Open Data Portal, California Health & Human Services Agency
- California Health Interview Survey, UCLA Center for Health Policy Research
- Childstats.gov, Federal Interagency Forum on Child and Family Statistics
- Community Commons: Community Health Needs Assessment
- County Health Rankings and Roadmaps, Robert Wood Johnson Foundation & University of Wisconsin Population Health Institute
- Data Resource Center for Child & Adolescent Health, Child and Adolescent Health Measurement Initiative
- Health Indicators Warehouse, National Center for Health Statistics
- National Survey Publications and Chartbooks, U.S. Dept. of Health and Human Services, Health Resources and Services Administration
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