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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic PediatricsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- The Uninsured in America: 1996–2000. Agency for Healthcare Research and Quality, Rockville, Md2002
- Leveling the playing field: managed care enrollment and hospital use, 1987–1996.Health Aff (Millwood). 2000; 19: 178-184
- Managed care for children: effect on access to care and utilization of health services.Future Child. 1998; 8: 39-59
- Trend data on medical encounters: tracking a moving target.Health Aff (Millwood). 2001; 20: 58-72
- HMO plan performance update: an analysis of the literature, 1997–2001.Health Aff (Millwood). 2002; 21: 63-86
- State of the States: Bridging the Health Coverage Gap. State Coverage Initiatives. Academy Health, Washington, DC2003
- Health care for children and youth in the United States: 2001 annual report on access, utilization, quality, and expenditures.Ambul Pediatr. 2002; 2: 419-437
- Annual report on access to and utilization of health care for children and youth in the United States—2000.Ambul Pediatr. 2001; 1: 3-15
- Annual report on access to and utilization of health care for children and youth in the United States—1999.Pediatrics (J Ambul Pediatr Assoc). 2000; 105: 219-230
- Patterns of Ambulatory Care Use: Changes From 1987 to 1996. Agency for Healthcare Research and Quality, Rockville, Md2001 (MEPS Research Findings No. 16. AHRQ publication 01-0026)
- Questionnaires and Data Collection Methods for the Household Survey and the Survey of American Indians and Alaskan Natives. National Center for Health Services Research and Health Care Technology Assessment, Rockville, Md1989 (National Medical Expenditure Survey Methods 2. DHHS publication 89-3450)
- Health Care Expenditures in the United States, 1996. Agency for Healthcare Research and Quality, Rockville, Md2000 (AHRQ publication 01-0009)
- A guide to comparing health care expenditures in the 1996 MEPS to the 1987 NMES.Inquiry. 2002; 39: 76-86
- Bureau of Labor Statistics, Monthly Labor Review and Handbook of Labor Statistics.(Accessed December 12, 2003)
- Consumer Assessment of Health Plans Study (CAHPS). Foreword.Med Care. 1999; 37: MS1-MS9
- SUDAAN User's Manual, Release 7.5. Research Triangle Institute, Research Triangle Park, NC1997
- Changes in the NIS Sampling and Weighting Strategy for 1998, January 18, 2002. Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, Rockville, Md2002
- Clinical Classifications for Health Policy Research. Hospital Inpatient Statistics, HCUP-3 Research Note. 177. AHCPR, Rockville, Md1995
- 5th ed. International Classification of Disease, Ninth Revision, Clinical Modification. Vols I–III. Public Health Service, Washington, DC1994 (DHHS publication 94-1260)
- The ABCs of children's health care: how the Medicaid expansions affected access, burdens and coverage between 1987 and 1996.Inquiry. 2003; 40: 133-145
- Interim Evaluation Report: Congressionally Mandated Evaluation of the State Children's Health Insurance Program. Mathematics Policy Research, Princeton, NJFebruary 26, 2003
- Which children are still uninsured and why.Future Children. 2003; : 13
- Public insurance expansions and crowd out of private coverage.Med Care. 2003; 41: 344-356
- SCHIP making progress: increased take-up contributes to coverage gains.Health Aff (Millwood). 2003; 22: 163-172
- Public insurance expansions and crowd out of private coverage.Med Care. 2003; 41: 337-340
- Crowd out: evidence from the Florida Healthy Kids Program.Pediatrics. 1999; 104: 507-513
- The Effects of SCHIP on Children's Health Insurance Coverage: An Update Based on Three Rounds of the Community Tracking Study, 1996–97 to 2000–01. Center for Studying Health System Change, Washington, DCDecember 2002
- The effects of Medicaid expansions on insurance coverage of children.Future Children. 1996; 6: 152-161
- Changes in the daily practice of primary care for children.Arch Pediatr Adolesc Med. 1998; : 152
- The impact of managed care on children's access, satisfaction, use, and quality of care.Health Serv Res. 2001; 36: 315-334
- Generation differences in hospital inpatient care of children aged 1 to 5 years.J Epidemiol Commun Health. 1993; 47: 149-152
- Children and managed care: what research can, can't, and should tell us about impact.Med Care Res Rev. 1999; 56: 13-36
- HMO plan performance update: an analysis of the literature, 1997–2001.Health Aff (Millwood). 2002; 21: 63-86
- Does managed care lead to better or worse quality of care?.Health Aff (Millwood). 1997; 16: 7-25
- Managed care plans: characteristics, growth, and premium performance.Annu Rev Public Health. 1994; 15: 437-459
- Leveling the playing field: managed care enrollment and hospital use, 1987–1996.Health Aff (Millwood). 2000; 19: 178-184
- Evaluation of New York State's Child Health Plus: access, utilization, quality of health care, and health status.Pediatrics. 2000; 105: 711-718
- Recent trends in hospital use by children in England.Arch Dis Child. 2001; 85: 203-207
- Assessing the appropriateness of paediatric hospital admissions in the United Kingdom.J Public Health Med. 2000; 22: 231-238
- Changes in children's hospital use.Health Rep. 1999; 11 (19–21): 9-19
- Psychiatric inpatient, outpatient, and medication utilization and costs among privately insured youths, 1997–2000.Am J Psychiatr. 2003; 160: 757-764
- Trends in childhood asthma: prevalence, health care utilization, and mortality.Pediatrics. 2002; 110: 315-322
- Surveillance for asthma—United States, 1980–1999.Morbid Mortal Wkly Rep Surveill Summ. 2002; 51: 1-13
- Associations between maternal and child health status and patterns of medical care use.Ambul Pediatr. 2002; 2: 85-92
- Health care utilization and expenditures associated with child care attendance: a nationally representative sample.Pediatrics. 2003; 111: e371-e375
- Narrowing the gap: decreasing emergency department use by children enrolled in the Medicaid program by improving access to primary care.Arch Pediatr Adolesc Med. 2000; 154: 791-795
- Association of lower continuity of care with greater risk of emergency department use and hospitalization in children.Pediatrics. 2001; 107: 524-529
- Pediatric emergency department utilization within a statewide Medicaid managed care system.Acad Emerg Med. 2002; 9: 296-299
- Measuring ambulatory health care use in the United States: a comparison of 1996 estimates across four Federal surveys.J Econ Soc Measure. 2001; 27: 57-69
- Impact of a children's health insurance program on newly-enrolled children.JAMA. 1998; 279: 1820-1825
- The impact of dental benefits on the utilization of dental services by low-income children in western Pennsylvania.Pediatric Dent. 2002; 24: 234-240
- The impact of a state children's health insurance program on access to dental care.J Am Dent Assoc. 2002; 133 (quiz 767–768): 707-714
- Are Children Accessing the Care They Need? An Assessment of Benefits and Service Delivery Arrangements Under SCHIP. Health Policy Center, The Urban Institute, Washington, DC2001 (2001 Annual Research Meeting Abstract)
- Does gatekeeping control costs for privately insured children? Findings from the 1996 medical expenditure panel survey.Pediatrics. 2003; 111: 456-460
- Evaluating Child Health Plus in upstate New York: how much does providing health insurance to uninsured children increase health care costs?.Pediatrics. 2000; 105: 728-732
- How much did the Medicaid expansions for children cost? An analysis of state Medicaid spending, 1984–1994.Med Care Res Rev. 2001; 58: 482-495
- Health insurance and the demand for medical care.Am Econ Rev. 1987; 77: 251-277
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.
