Objective.—This report provides an update on insurance coverage, use of health care services,
and health expenditures for children and youth in the United States. In addition,
the report provides information on variation in hospitalizations for children from
a new 22-state hospital discharge data source.
Methods.—The data on insurance coverage, utilization, and expenditures come from the Medical
Expenditure Panel Survey. The data on hospitalizations come from the Database for
Pediatric Studies, which is part of the Healthcare Cost and Utilization Project. Both
data sets have been prepared by the Agency for Healthcare Research and Quality.
Results.—Few changes in insurance coverage occurred between 1996 and 1998. About two thirds
of American children are covered by private insurance and 19% by public sources; the
remaining 15% are uninsured. Of the 71.5% of children who have at least 1 doctor's
office visit, the average number of visits was 3.9, but this ranged from 2.7 among
the uninsured to 4.2 for those with private insurance. Slightly more than half of
children had a prescription, and these averaged 5.4 prescriptions. The majority of
children (85%) incur medical expenditures, averaging $1019 for children with any expenditure.
Private health insurance was by far the largest payer of medical care expenses for
children, even more so than among the general population. However, nearly 21% of expenditures
for children's health care were paid out of pocket by children's families. The data
also show substantial differences in average length of hospitalization across states,
ranging from 2.7 to 4.0 days, and rates of hospital admission through the emergency
department, which vary across states from 9% to 23%. Injuries are a major reason for
hospitalization, accounting for 1 in 6 hospital stays among 10- to 14-year-olds. In
the 10–17 age group, 1 in 7 hospital stays are due to mental disorders. Among 15-
to 17-year-olds, more than one third of all hospital stays are related to childbirth
and pregnancy.
Conclusion.—Children's use of health care services varies considerably by what type of health
insurance coverage they have. Expenditures for children entail a substantial out-of-pocket
component, which may be quite large for children with major health problems and which
may represent a significant burden on lower-income families. Substantial variation
in hospitalization exits across states.
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Article info
Publication history
Accepted:
September 26,
2000
Received:
August 14,
2000
Identification
DOI: https://doi.org/10.1367/1539-4409(2001)001<0003:AROATA>2.0.CO;2
Copyright
© 2001 The Ambulatory Pediatric Association. Published by Elsevier Inc. All rights reserved.
