Health Care

Spotlight on Key Indicators: Health Care

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Health Care
Characteristics of Children with Special Needs
Access to Services for Children with Special Health Care Needs
Insurance Coverage for Children with Special Health Care Needs
Quality of Care 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). 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’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:

2.  As cited on, 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:

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:

5.  American Academy of Pediatrics, Council on School Health. (2012). School-based health centers and pediatric practice. Pediatrics, 129(2), 387-393. Retrieved from:

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:
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:
  • 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)
For more policy ideas and research on this topic, see's Research & Links section or visit the California HealthCare Foundation, the National Academy for State Health Policy, and the American Academy of Pediatrics.

Sources for this narrative:

1.  Children’s Defense Fund-California. (n.d.). Children’s health. Retrieved from:

2.  The Children’s Partnership. (2016). The Affordable Care Act and children’s coverage in California: Our progress and our future. Retrieved from:

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:

4.  American Academy of Pediatrics, Committee on Pediatric Workforce. (2013). Pediatrician workforce policy statement. Pediatrics, 132(2), 390-397. Retrieved from:

5.  Hamilton, E. R., & Evans, E. (n.d.). State health insurance policy and insuring immigrant children. UC Davis Center for Poverty Research. Retrieved from:

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:

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:

8.  Alker, J., & Chester, A. (2014). Children's coverage at a crossroads: Progress slows. Georgetown University Center for Children and Families. Retrieved from:

9.  Coller, R. J., et al. (2015). The medical home and hospital readmissions. Pediatrics, 136(6), e1550-e1560. Retrieved from:

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:

11.  McConville, S. (2016). California's future: Health care. Public Policy Institute of California. Retrieved from:

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:
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