If all states offered the same quality of health care to children as did Iowa, Vermont, Maine, Massachusetts and New Hampshire, 4.6 million more children in the nation would have health insurance, a new report suggests.
The report from the Commonwealth Fund, New York, ranked those 5 states at the top in the quality of health care available to their youngest residents.
Lowest-ranked states for children's health care were Arizona, Louisiana, Mississippi, Florida and Oklahoma.
The rankings were based on 13 measures, grouped under 5 performance dimensions: access, quality, costs, potential to lead healthy lives and equity. The last component measured access to care in relation to income, race-ethnicity and insurance coverage.
Conditions measured included percentage of children who were insured and rates of infant mortality, vaccinations, preventive care, developmental delays, medical spending levels and outcomes of medical treatments.
Despite federal and state programs to assure health insurance coverage for children, the report found some states do much better than others in promoting the health and mental development of their children.
The Commonwealth Fund authors–Katherine Shea, Karen Davis and Edward Schor–contend that top-ranked states show high performance is possible. For instance, Iowa and Vermont had developed children's health care system that put outstanding care within reach of most children, regardless of such demographic attributes as income. At the same times, these programs controlled spending and the cost of family health care premiums. Both states expanded their State Children's Health Insurance Program, which was enacted by Congress in 1997 to increase coverage of children in low-income families.
The Commonwealth Fund also found that states in the top quartile of best-performing states in general rated highly on several indicators, including having relatively low uninsured rates for children. In addition to the top 5, these states included Ohio, Hawaii, Rhode Island and Kentucky.
The states at the bottom quartile lagged well behind top states in such quality indicators as infant mortality, risk of development delay and percent covered by insurance. These lower-ranked states included Texas, Illinois, New Mexico, Alaska, New Jersey and Oregon.
The proportion of children who are uninsured ranged from a low of 5% in Michigan to a high of 20% in Texas, the researchers found. The ratio of children having regular medical and dental preventive care ranged from 75% in Massachusetts to 46% in Idaho, while the proportion hospitalized for asthma varied from 55 per 100,000 children in Vermont to 314 per 100,000 in South Carolina, among 33 states reporting this figure.
To help gauge excellence of care, the report also used the concept of the medical home, which is a health care provider that gives each member a preventive-care visit annually, provides access to urgent care and to specialists when needed, and provides other essential health services.
The Fund found 61% of children in New Hampshire and over half of all children in all the New England States have a medical home, compared with only a third of those in Mississippi.
The authors found ample opportunities for all states to improve health care for children, including in those states they rated highly.
Across all states, 65% of uninsured and 51% of poor people did not receive recommended levels of medical and dental care, while only 37% of insured children and 30% of higher-income children failed to get those services.
