Objective.—To examine changes in insurance coverage, health care utilization, perceived quality
of care, and expenditures for children and youth in the United States using data from
1987–2001.
Methods.—Three national health care databases serve as the sources of data for this report.
The Medical Expenditure Panel Survey (1996–2001) provides data on insurance coverage,
utilization, expenditures, and perceived quality of care. The National Medical Expenditure
Survey (1987) provides additional data on utilization and expenditures. The Nationwide
Inpatient Sample (1995–2000) from the Healthcare Cost and Utilization Project provides
information on hospitalizations.
Results.—The percent of children uninsured for an entire year declined from 10.4% in 1996 to
7.7% in 1999. Most changes in children's health care occurred between 1987 and the
late 1990s. Overall utilization of hospital-based services has declined significantly
since 1987, especially for inpatient hospitalization. Several of the observed changes
from 1987 varied significantly by type of health insurance coverage, poverty status,
and geographic region. Quality of care data indicate some improvement between 2000
and 2001, which varies by insurance coverage. Overall, mean length of stay of hospitalizations
did not change significantly from 1995 to 2000, but changes in the prevalence of hospitalizations
and the length of stay associated with age-specific diagnoses were evident during
this time period.
Conclusions.—Health care for children and youth has changed significantly since 1987, with most
of the changes occurring between 1987 and 1996. Insurance coverage has improved, the
site of care has shifted toward ambulatory sites, hospital utilization has declined,
and expenditures on children as a proportion of total expenditures have decreased.
Variation in these changes is evident by insurance status, poverty, and region.
KEY WORDS
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Article Info
Publication History
Accepted:
September 27,
2003
Received:
July 9,
2003
Identification
DOI: https://doi.org/10.1367/1539-4409(2004)4<131:HCFCAY>2.0.CO;2
Copyright
© 2004 Ambulatory Pediatric Association. Published by Elsevier Inc. All rights reserved.
