School Provides Adequate Health Services (Staff Reported)
Definition: Percentage of responses by public school staff on the extent to which they agree their school provides adequate health services for students (e.g., in 2013-2015, 18.8% of responses by high school staff in California reported strong agreement that their school provides adequate health services).
Footnote: Years presented comprise two school years (e.g., 2013-14 and 2014-15 school years are shown as 2013-2015). This question was asked of all surveyed staff in the 2011-12 school year. In 2012-13, 2013-14, and 2014-15 only staff reporting responsibility for services or instruction related to health, prevention, discipline, counseling, or safety were asked to respond. Data are unweighted. K-12 schools are classified according to the grade levels with greatest enrollment (e.g., schools with more students in the elementary grades than in the middle or high school grades are classified as elementary schools). Students in non-traditional programs are those enrolled in community day schools or continuation education. The notation S refers to data that have been suppressed because (a) there were fewer than 5 respondents in that group, or (b) the sample was too small to be representative. N/A means that data are not available.
* Public health insurance includes both means-tested coverage (e.g., Medicaid/Medi-Cal, CHIP) and non-means-tested coverage (e.g., Dept. of Defense TRICARE, Indian Health Service). Means testing considers financial circumstances in determining eligibility.
† Medicaid is a federal program providing health coverage to eligible low-income children and families; Medi-Cal is California's Medicaid program. CHIP (Children’s Health Insurance Program) is a federal program providing coverage to children/youth up to age 19 in families with incomes too high to qualify them for Medicaid, but too low to afford private coverage. California’s CHIP program was called the Healthy Families Program (HFP). Although California continues to receive CHIP funding, in 2013 HFP enrollees were transitioned into Medi-Cal.
‡ 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.”
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 regular preventive check-ups (which can lead to the early identification and treatment of problems) and are less likely to have emergency room visits (1). However, the latest estimates indicate that less than half of children receive care within a medical home, statewide and nationally (2). Not surprisingly, children without health insurance are less likely to access needed care than those with coverage (3). While the number of insured children has increased in recent years, some remain uninsured and many are at risk of losing coverage if investments in public insurance programs are not maintained (3).
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. More than 2,300 SBHCs operate nationwide (4). 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. SBHCs can lead to improved access to medical and dental care, health outcomes, and school performance (5, 6). They also reduce emergency room visits and health care costs (5, 6).
For more information on health care, see kidsdata.org’s Research & Links section.
In 2016, 97% of California children ages 0-17 were estimated to have some form of health insurance coverage—up from 91% in 2009—yet gaps remained. For example, more than 6% of American Indian/Alaska Native children were uninsured in 2016, compared to less than 4% for all other racial/ethnic groups with data.
In the same year, an estimated 42% of California children and youth ages 0-21 had Medicaid (Medi-Cal), CHIP, or other means-tested public health insurance coverage, with enrollment estimates highest for infants (47%) and lowest for young adults ages 18-21 (31%). Statewide, coverage for African American/black and Hispanic/Latino groups was higher than 50% in 2016, whereas estimates for Asian/Pacific Islander and white children/youth were lower than 28%. In the 2016 federal fiscal year, total yearly enrollment in Medicaid and CHIP among California children ages 0-17 was 720 per 1,000, more than 20% higher than the national rate of 590 per 1,000.
Parent reports from 2016 show that 42% of the state's children receive care within a medical home, compared to 49% nationwide. In California counties with data, estimates of children receiving care within a medical home ranged from 33% (Imperial) to 50% (Placer).
In 2013-14, an estimated 88% of California youth ages 12-17 received a routine health check-up within the past 12 months, up from about 77% in 2001. However, about 7% of all California children—and 10% of lower-income children—had no usual source of health care in 2013-14. Estimates by race/ethnicity ranged from 5% (multiracial and white) to 11% (African American/black) with no usual source of care. Among children who did have a regular source of care, the majority (63%) used a doctor’s office or HMO, rather than hospitals, clinics, urgent care, emergency rooms, or other settings. For children living below 200% of the Federal Poverty Level, only 48% used a doctor’s office or HMO, compared to 77% for children from higher-income families.
School health centers provide access to health care for many children. In 2018, California had 258 school health centers, up from 153 in 2009. However, nearly half of the state's counties (27 of 58) did not have any school health centers in 2018. When asked whether their school provides adequate health services for students, 23% of responses from elementary school staff, 20% of responses by middle school staff, 19% of responses by high school staff, and 25% of responses by staff at non-traditional schools reported strong agreement in 2013-2015.
Children with health insurance are more likely to receive needed medical care, are less likely to have costly hospitalizations, and tend to perform better in school than their uninsured peers (1). Providing quality, accessible, and affordable health care to all children requires comprehensive insurance coverage and an appropriately trained and compensated provider base including a sufficient number of subspecialists; it also requires effective systems of care including medical homes and parental understanding about what care is needed and how to obtain it (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 (2, 5).
The 2010 Affordable Care Act (ACA), which expanded health care coverage and enacted other major health system changes, has increased the number of insured children in the state and nation (2). California also has enacted numerous policy and program changes in recent years, bolstering coverage and access to health care for millions of children and families (2). While progress has been made, ongoing efforts are needed to maintain these gains and to continue strengthening health care for children, particularly for low-income and vulnerable populations (2).
Policy options that could improve children’s health care include:
Supporting ongoing efforts to ensure continuous insurance coverage for all low-income children, including immigrant children; this includes maintaining and increasing investments in public insurance programs serving children and continuing to improve enrollment processes and community-based outreach to families (2, 5)
Ensuring that every child has access to family-centered, culturally competent, and coordinated care within a medical home, particularly children with chronic conditions (3, 6)
Increasing the number of health care providers serving children in Medi-Cal (California's Medicaid program) by improving financial incentives, and ensuring that reimbursement for pediatric visits covers the time required to focus on child/youth development and family-centered care (2, 4, 6)
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)
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 (6)
Monitoring the capacity and financial viability of safety-net providers, such as county hospitals, which are important sources of care for low-income people (7)
Promoting collaboration across sectors—health, education, social services, and others—to improve prevention, early intervention, and treatment services for children, and supporting a comprehensive approach to health care that goes beyond treating illness to addressing community factors that impact health, such as access to healthy food or safe housing; this could help reduce health inequities at the population level and lower costs related to preventable conditions (8, 9)