Summary:

Health Care

Spotlight on Key Indicators: Health Care
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Learn More About Health Care

Demographics
Demographics of Children with Special Needs
Access to Services for Children with Special Health Care Needs (State-Level Data)
Cancer
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)
Dental Care
Pupil Support Service Personnel
Health Care
Hospitalizations
Immunizations
Prenatal Care
Teen Sexual Health
Why This Topic Is Important
According to the American Academy of Pediatrics, every child should receive high quality, culturally competent, 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). According to 2011-12 estimates, 9% of U.S. children lacked a usual source of health care (3). Not surprisingly, children without health insurance are far more likely to have no usual source of care than children with insurance (4). In 2011-12, approximately 8.3 million U.S. children (11% of all kids) were uninsured at some point during the year (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 (5). 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 (5). 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 (6).

For more information on health care, see kidsdata.org’s Research & Links section.

Sources for this narrative:

1.  Hagan, J. F., et al. (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

2.  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/early/2011/03/14/peds.2009-3555

3. Child and Adolescent Health Measurement Initiative. National Survey of Children's Health. Data Resource Center for Child and Adolescent Health. Retrieved from: http://www.childhealthdata.org/learn/NSCH

4.  Federal Interagency Forum on Child and Family Statistics. (2013). Health care. America’s children: Key national indicators of well-being, 2013. Washington, DC: U.S. Government Printing Office. Retrieved from: http://www.childstats.gov/americaschildren/care.asp

5.  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/

6.  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

How Children Are Faring
In 2012, an estimated 92% of California children ages 0-17 had health insurance. Although the percentage of children with health insurance has increased slightly since 2009, gaps remain. According to 2012 estimates, 10% of Latino children in California did not have health insurance, compared to 6% of African American/Black, Asian American, and multiracial children, and 5% of white children.  

In 2012, over 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 (601 vs. 175.2 per 1,000 in 2011, respectively). African American children/youth have the highest enrollment rates among all racial/ethnic groups with available data in California (570.2 per 1,000 in 2011).

Among youth ages 12-17, 86% received a routine health check-up within the past 12 months in 2011-12, up from an estimated 77% in 2001. However, according to 2011-2012 data, less than half (45%) of California children ages 0-17 received care within a “medical home,” compared to 54% nationwide. In California and nationwide, older, low-income, Latino, and African American children were less likely to have a medical home.
School health centers provide access to health care for many children. According to 2013 data, California has 226 school health centers, up from 153 in 2009. However, school health centers are not dispersed equally across the state. In 2013, a majority of counties (31 of 58) did not have any school health centers, and Los Angeles County alone had almost one-third of all health centers in the state.
Policy Implications
When children have health insurance, they are more likely to receive preventive and acute care, they miss less school, and their families are at less financial risk from unpaid medical bills (1, 2). 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 a “medical home” (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).

The 2010 passage of the federal Affordable Care Act (ACA) will allow an estimated 95% of children in the U.S. access to affordable health care (9). The ACA expands Medicaid, the government health insurance program for low-income people, ensuring coverage of children in families earning up to 133% of the federal poverty level (10). In addition, families with incomes between 133%-400% of the federal poverty level, and without affordable employer-based coverage, will be eligible for subsidies to purchase coverage through the state's Health Benefit Exchange (10). ACA also prohibits discrimination based on pre-existing conditions and makes significant investments in school-based health care and infant care (11).

According to research and subject experts, policy options that could improve children’s health care include: 
  • Maintaining continuous insurance coverage for all low-income children, including immigrant children (1, 2)
  • Ensuring that every child has access to family-centered, culturally competent and coordinated care within a medical home, particularly children with chronic conditions (3, 5, 7)
  • Expanding access to health education and consultation services for parents/guardians and service providers in programs that serve young children, including child care settings, nutrition programs, and foster care homes (5)
  • Ensuring that training is provided to 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 (3, 6)
  • 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)
  • Ensuring that public insurance reimbursement for pediatric visits covers the time required to focus on child/youth development, family-centered care and – for teens – sexual and reproductive health (2, 5)
For more policy ideas and research on this topic, see kidsdata.org's Research & Links section or visit the California HealthCare Foundation, the 100% Campaign, and the American Academy of Pediatrics

Sources for this narrative:

1.  Galbraith, A., et al. (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://www.100percentcampaign.org/coverage/?_c=y6v0ow3cdxxnin

3.  American Academy of Pediatrics. (2012). 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

4.  Center for Poverty Research. (2013). Policy brief: State health insurance policy and insuring immigrant children. Retrieved from: http://poverty.ucdavis.edu/research-paper/policy-brief-state-health-insurance-policy-and-insuring-immigrant-children

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. (2013). Children with special health care needs: A profile of key issues in California. Retrieved from: http://lpfch-cshcn.org/publications/research-reports/children-with-special-health-care-needs-in-california-a-profile-of-key-issues/

8.  Mathematica Policy Research. (2012). Health-e-App public access: A new online path to children’s health care coverage in California. Retrieved from: http://www.mathematica-mpr.com/Health/health-e-app.asp

9.  Children’s Defense Fund. (2011). New investments to help children and families: The Patient Protection and Affordable Care Act and the maternal, infant, and early childhood home visiting program. Retrieved from: http://www.childrensdefense.org/child-research-data-publications/data/new-investments-to-help-children-early-childhood-home-visiting-program.pdf

10.  Georgetown University Health Policy Institute: Center for Children and Families. (2010). Summary of Medicaid, CHIP, and low-income provisions in health care reform. Retrived from: http://ccf.georgetown.edu/ccf-resources/summary-of-medicaid-chip-and-low-income-provisions-in-health-care-reform

11.  100% Campaign. (2012). Affordable Care Act: Top 11 benefits for California children and youth. Retrieved from: http://www.100percentcampaign.org/whatsnew/release.php?_c=11l5uswjv7q5w3z&1=1&id=10fdraalsifds47&done=.11l5utg1j5r2wdn

Websites with Related Information
Key Reports
County/Regional Reports
More Data Sources For Health Care