- 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 20,000 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
- Medical Home Access (California & U.S. Only)
- Adequate Health Services Provided at School (Staff Reported)
- School Health Centers
- Demographics of Children with Special Needs
- Percentage of Insured/Uninsured Children Who Have Special Health Care Needs (California & U.S. Only)
- Percentage of Insured/Uninsured Children Who Have Major Disabilities, by City, School District, and County (Regions of 65,000 Residents or More)
- Access to Services for Children with Special Health Care Needs (State-Level Data)
- Children with Special Health Care Needs Who Needed Five or More Services
- Children with Special Health Care Needs Who Had Preventive Medical Visit in the Last Year
- Difficulty Accessing Community-Based Services for Children with Special Health Care Needs
- Early Intervention for Children with Special Health Care Needs
- Referrals to Specialty Care for Children with Special Health Care Needs
- Unmet Medical Care Needs Among Children with Special Needs
- Unmet Needs for Mental Health Care Among Children with Special Health Care Needs
- Unmet Needs for Preventive Dental Care Among Children with Special Health Care Needs
- Usual Source of Health Care Among Children with Special Health Care Needs
- Youth with Special Health Care Needs Who Received Needed Services for the Transition to Adulthood
- Insurance Coverage for Children with Special Health Care Needs (State-Level Data)
- Quality of Care for Children with Special Health Care Needs (State-Level Data)
- Children with Special Health Care Needs Who Receive Care that Meets Federal Minimum Quality Standards
- Family-Centered Health Care for Children with Special Health Care Needs
- Medical Home for Children with Special Health Care Needs
- 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). In the first half of 2014, an estimated 10% of U.S. children were uninsured at least part of past 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). They also have been shown to reduce emergency room visits and health care costs (5).
For more information on health care, see kidsdata.org’s Research & Links section.
Sources for this narrative:
1. Strickland, 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.full
2. As cited on kidsdata.org, National Survey of Children's Health. (2011-2012). Child and Adolescent Health Measurement Initiative, Data Resource Center for Child and Adolescent Health. Retrieved from: http://www.kidsdata.org/topic/271/medicalhome/table
3. Alker, J. & Chester, A. (2014). Children's coverage at crossroads: Progress slows. Georgetown University Health Policy Institute Center for Children and Families. Retrieved from: http://ccf.georgetown.edu/wp-content/uploads/2014/10/Childrens-Coverage-at-a-Crossroads.pdf
4. Martinez, M. & Cohen, R. (2014). Health insurance coverage: Early release of estimates from the National Health Interview Survey, January-June 2014. National Center for Health Statistics. Retrieved from: http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201412.pdf
5. American Academy of Pediatrics, Council on School Health. (2012). Policy statement: School-based health centers and pediatric practice. Pediatrics, 129(2), 387-393. Retrieved from: http://pediatrics.aappublications.org/content/129/2/387.full
- How Children Are Faring
In 2013, an estimated 93% of California children under age 18 had health insurance. Although the percentage of children with health insurance has increased slightly since 2009, gaps remain. For example, among racial/ethnic groups in California, 2013 estimates of children without insurance were 12% for American Indians/Alaska Natives, 11% for Native Hawaiians/Pacific Islanders, 10% for Latinos, 6% for Asian Americans, and 5% for African American, white, and multiracial children.
In 2012, more than 4 million children and youth ages 0-21 in California were enrolled in the Medi-Cal program: 353.4 per 1,000. The number and rate of enrollees has increased since 2007. Enrollment rates are highest among infants and lowest among young adults ages 19-21. African American children/youth have the highest enrollment rates (570.2 per 1,000 in 2011) among all racial/ethnic groups with available data in California.
Among California youth ages 12-17, an estimated 86% received a routine health check-up within the past 12 months in 2011-12, up from about 77% in 2001. However, 2011-12 data also show that fewer than half (45%) of the state's children under age 18 received care within a “medical home,” compared to 54% nationwide. In California and the U.S., older, low-income, Latino, and African American children were less likely to have a medical home (note: comparison data are not available for all racial/ethnic groups).School health centers provide access to health care for many children. In 2015, California had 231 school health centers, up from 153 in 2009. However, more than half of the state's counties (30 of 58) did not have any school health centers in 2015.
In 2011-13, 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 had the lowest.
- Policy Implications
Children with health insurance are more likely to receive needed medical care and have improved school performance, 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” (1, 2, 3). 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 (4, 5).
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 million U.S. children and nearly 600,000 California children remained uninsured in the first half of 2014 (6, 7). Continued, effective implementation of the ACA, including efforts to streamline enrollment and renewal processes, will influence progress in future years (6).
According to research and subject experts, 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 (1, 4, 5, 6)
- Ensuring that every child has access to family-centered, culturally competent, and coordinated care within a medical home, particularly children with chronic conditions (2)
- 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 (8)
- Ensuring that training is provided to pediatricians on medical home implementation and management of care for children with special health care needs; ensuring that there is an adequate number of trained pediatric specialty care providers; and implementing training and recruitment strategies to increase culturally effective pediatric care (2, 3)
- Continuing efforts to streamline and integrate state and county insurance enrollment and renewal systems (9)
- Encouraging and supporting participation of safety-net providers, such as county hospitals, in the systems used by Medi-Cal (California's Medicaid program) and Covered California, the state's insurance marketplace under the ACA (9)
- Ensuring that public insurance reimbursement for pediatric visits covers the time required to focus on child/youth development and family-centered care (3, 8)
- 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 (9, 10)
Sources for this narrative:
1. The 100% Campaign. (2013). Facts about health coverage for children in California. The Children's Partnership, Children Now, and Children's Defense Fund-California. Retrieved from: http://www.100percentcampaign.org/publications/?_c=12ttmsypq4zlobu
2. Strickland, 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.full
3. American Academy of Pediatrics, Council on Pediatric Workforce. (2013). Pediatrician workforce policy statement. Pediatrics, 132(2), 390-397. Retrieved from: http://pediatrics.aappublications.org/content/132/2/390.full
4. Hamilton, E. & Evans, E. (2013). Policy brief: State health insurance policy and insuring immigrant children. Center for Poverty Research, UC Davis. Retrieved from: http://poverty.ucdavis.edu/research-paper/policy-brief-state-health-insurance-policy-and-insuring-immigrant-children
5. 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.full
6. Alker, J. & Chester, A. (2014). Children's coverage at crossroads: Progress slows. Georgetown University Health Policy Institute Center for Children and Families. Retrieved from: http://ccf.georgetown.edu/wp-content/uploads/2014/10/Childrens-Coverage-at-a-Crossroads.pdf
7. Martinez, M. & Cohen, R. (2014). Health insurance coverage: Early release of estimates from the National Health Interview Survey, January-June 2014. National Center for Health Statistics. Retrieved from: http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201412.pdf
8. Zero to Three. (2012). Ensuring good physical health of our infants and toddlers. Retrieved from: http://www.zerotothree.org/public-policy/policy-toolkit/healthsinglesmar5.pdf
9. McConville, S. (2014). California's future: Health care. Public Policy Institute of California. Retrieved from: http://www.ppic.org/main/publication.asp?i=102
- Websites with Related Information
- California Coverage & Health Initiatives
- California HealthCare Foundation
- California School-Based Health Alliance
- Center for Children & Families, Georgetown University Health Policy Institute
- Family Health Outcomes Project, UCSF
- Health Affairs
- Health Insurance and Access to Care Knowledge Path, Maternal and Child Health Library at Georgetown University
- 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, George Washington University
- The Children's Partnership: Children's Health Care/Health Reform
- The Commonwealth Fund
- UCLA Center for Health Policy Research
- Key Reports
- A New Pediatrics for a New Century, 4/2013, Pediatrics, Lantos, J. & Ward, N.
- Aiming Higher: Results from a Scorecard on State Health System Performance, 4/2014, The Commonwealth Fund
- California 2014 CHIP Fact Sheet, 2014, American Academy of Pediatrics & National Academy for State Health Policy
- California and Its Counties Under the ACA: A Leadership Framework, 5/2014, California HealthCare Foundation, Kelch, D.R.
- California's Future, 2014, Public Policy Institute of California
- Caring for Children, 12/2014, Health Affairs, Weil, A.
- Children’s Coverage at a Crossroads: Progress Slows, 11/2014, Georgetown University Health Policy Institute Center for Children & Families, Alker, J. & Chester, A.
- Children’s Health Insurance Program (CHIP): Accomplishments, Challenges, and Policy Recommendations, 3/2014, Pediatrics, Committee on Child Health Financing
- Enhancing Pediatric Workforce Diversity and Providing Culturally Effective Pediatric Care: Implications for Practice, Education, and Policy Making, 10/2013, Pediatrics, Committee on Pediatric Workforce
- Enrollment in Health and Nutrition Safety Net Programs among California's Children, 2/2015, Public Policy Institute of California, Beck, L., et al.
- Including Safety-Net Providers in Integrated Delivery Systems: Issues and Options for Policymakers, 8/2012, The Commonwealth Fund & The National Academy for State Health Policy, Witgert & Hess
- Patient- and Family-Centered Care Coordination: A Framework for Integrating Care for Children and Youth Across Multiple Systems, 5/2014, Pediatrics, Council on Children with Disabilities and Medical Home Implementation Project Advisory Committee
- Providing Care for Immigrant, Migrant, and Border Children, 6/2013, Pediatrics, Council on Community Pediatrics
- Racial and Ethnic Disparities in the Health and Health Care of Children, 7/2013, Pediatrics, Flores, G.
- School-Based Health Alliance Policy Statements, 2012, School-Based Health Alliance
- School-Based Health Centers and Pediatric Practice, 2/2012, Pediatrics, Council on School Health
- The Changing Nature of Children’s Health Development: New Challenges Require Major Policy Solutions, 12/2014, Health Affairs, Halfon, N., Wise, P. & Forrest, C.
- The Patient-Centered Medical Home, Electronic Health Records, and Quality of Care, 6/3/2014, Annals of Internal Medicine, Kern, L. M., et al.
- County/Regional Reports
- Children's Report Card: Sacramento County Children's Coalition, 2013
- Fresno Community Scorecard, Fresno Business Council and Valley PBS
- Los Angeles County: Key Indicators of Health by Service Planning Area, 2013, Los Angeles County Department of Public Health
- Los Angeles: Fragmented Health Care Market Shows Signs of Coalescing, 2013, California HealthCare Foundation, Center for Studying Health System Change
- Orange County Community Indicators Report, 2014
- San Diego County Report Card on Children and Families, 2013, 2014, The Children's Initiative
- Santa Clara County Children's Agenda: 2014 Data Book, Planned Parenthood and Kids in Common
- Solano County Children's Report Card, 2014, Children's Network
- More Data Sources For Health Care
- California Health and Human Services Open Data Portal, California Department of Public Health
- California Health Interview Survey, UCLA Center for Health Policy Research
- Child Health USA, U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau
- Childstats.gov, Federal Interagency Forum on Child and Family Statistics
- Community Commons
- County Health Rankings & Roadmaps, Robert Wood Johnson Foundation
- Health Indicators Warehouse, National Center for Health Statistics
- Health Profiles: Child and Teen, 2012, UCLA Center for Health Policy Research
- Health Profiles: Legislative Districts, 2012, UCLA Center for Health Policy Research