The Children's Health Insurance Program Lessons for Health ReformThe articles in this special Academic Pediatrics' supplement present a thoughtful analysis of the Children's Health Insurance Program (CHIP) contribution to the advancement of child health policy in the United States. CHIP has played a significant role in reducing the proportion of uninsured children in the United States, not only through the coverage subsidies it provides to millions of children, but also because of the heightened policy focus it has brought to the question of how to structure insurance for children and make coverage accessible.
The Children's Health Insurance Program Strengthens Children's Health CareThe Children's Health Insurance Program (CHIP) has provided substantial coverage for critical groups of children and youth since its inception in the 1990s. Meant to cover children in households with incomes greater than financial eligibility for Medicaid but unable to obtain health insurance through a parent's workplace, CHIP has played a major role in achieving the lowest rate of uninsurance among America's children ever.1 With current funding through the Affordable Care Act (ACA) (and due to expire in September 2015), CHIP also serves, along with Medicaid's Early and Periodic Screening, Diagnosis, and Treatment program, as health insurance tailored specifically to the needs of children.
The Children's Health Insurance Program and the Goldilocks EffectDid you ever read the story of Goldilocks to your children? In one version of this story, Goldilocks is a tired, hungry, and lost little girl who encounters a house owned by 3 bears. She finds 3 bowls of porridge and judges whether each is too hot, too cold, or just right. She then finds 3 chairs, and determines whether each is too big, too small, or just right. Finally she is tired and finds 3 beds, and she assesses whether each bed is too hard, too soft, or just right. After she eats the porridge, sits in the chair, and lies on the bed that are all “just right,” she falls asleep.
Alabama's Perspective of the Child Health Insurance ProgramThe articles in this supplement report on a Congressionally mandated evaluation of the Children's Health Insurance Program (CHIP) and highlight the effects of the program on insurance coverage and access to care in 10 study states. Here, we provide some insights on how CHIP has found success in Alabama by providing coverage to uninsured children and ensuring they have access to quality health care.
The Children's Health Insurance Program Reauthorization Act Evaluation Findings on Children's Health Insurance Coverage in an Evolving Health Care LandscapeThe Children's Health Insurance Program (CHIP) Reauthorization Act (CHIPRA) reauthorized CHIP through federal fiscal year 2019 and, together with provisions in the Affordable Care Act, federal funding for the program was extended through federal fiscal year 2015. Congressional action is required or federal funding for the program will end in September 2015. This supplement to Academic Pediatrics is intended to inform discussions about CHIP's future. Most of the new research presented comes from a large evaluation of CHIP mandated by Congress in the CHIPRA.
Kinship CareAbout 4.2% (3.1 million) of children in the United States, according to census data,1 reside with relatives or close family connections and with neither parent, an arrangement termed kinship care (KC). Health professionals frequently encounter children in KC and may better serve these children if they are aware of both the benefits and complexities of kinship arrangements.
Quality Concerns in Antipsychotic Prescribing for Youth: A Review of Treatment GuidelinesAntipsychotic prescribing for youth has increased rapidly, is linked with serious health concerns, and lacks clear measures of quality for pediatric care. We reviewed treatment guidelines relevant to 7 quality concepts for appropriate use and management of youth on antipsychotics: 1) use in very young children, 2) multiple concurrent antipsychotics, 3) higher-than-recommended doses, 4) use without a primary indication, 5) access to psychosocial interventions, 6) metabolic screening, and 7) follow-up visits with a prescriber.
Patient Reported Outcomes as Indicators of Pediatric Health Care QualityHealth care reform has increased demand for pediatric health care quality evaluations, particularly those that assess the impact of care on patient and population health outcomes. Many of today's most common childhood conditions are characterized by symptoms, behaviors, and functional limitations that are best assessed as patient reported outcomes (PROs). Although they remain greatly underutilized, PROs have the potential to improve pediatric health care quality assessment at the point of care and through system-level performance evaluations.
Advancing the Science of Measurement in Pediatric Quality of CareThe Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 provides an opportunity to consider and enhance the measurement of children's health care quality as a means to improve child health.1 The legislation required the identification of an initial child core set of measures for voluntary use by Medicaid/Child Health Insurance (CHIP) programs. The initial child core set was published in 2009, and after its most current update in 2014, the list now includes 23 pediatric measures.
Growing Up Poor: A Pediatric ResponseThe original mission of Boston City Hospital, established in 1864, now Boston Medical Center (BMC), was to provide medical care to all regardless of race, ethnicity, or ability to pay. Nationally, health insurance for children has increased, although disparities by race and income remain.1 However, despite the largest expansion of health insurance in the nation, covering 97% of Massachusetts children and biomedical treatment advances, the low-income and minority children seen at BMC continue to suffer disproportionally from low birth weight, asthma, learning disabilities, and most health problems compared to their nonpoor peers.
Stories That WorkI have never met Natoma Canfield, but I am unlikely to forget her story. Natoma is a woman with cancer who had dutifully paid her health insurance premiums over the years she was healthy but then could no longer afford them when she became sick, and they increased. Ultimately, she lost coverage. Natoma's story was the one President Barack Obama relayed on the historic day last summer that the Patient Protection and Affordable Care Act was upheld by the Supreme Court. Her experience encapsulated the health care debate at a time when all the facts—the pros, the cons—were questioned by the other side.
Health Care for Children and Youth in the United States: 13 Years of EvidenceEditor's Note: One of the challenges of leading such an agency as the Agency for Healthcare Research and Quality (AHRQ) is disseminating its products in a way that can be used by a variety of individuals for whom it is important. Dr. Clancy has met this challenge with a number of innovative reports and other strategies in providing readily used access to the analytic and policy products of AHRQ. The Annual Report in Academic Pediatrics is one of those strategies with a focus on access and use of health services by children and youth, a group often not well described in general population data.
Notes to a Young Investigator on How We Might Change the WorldI'd like to express my sincere gratitude to the APA for this tremendous honor and recognition. I am also extremely grateful to my mentors: my high-school biology teacher, Ben Kirkland; my college mentor, Ernest Williams; my Robert Wood Johnson Clinical Scholars Program mentors, Alvan Feinstein and Ralph Horwitz; my Robert Wood Johnson Harold Amos Medical Faculty Development Program mentor, Sandy Schwartz; and my cherished pediatric colleagues and mentors, Michael Weitzman, Paul Wise, and Fernando Mendoza.
The United States 2012 General Election: Making Children's Health and Well-Being a Priority for the CandidatesIn the first half of the 20th century, perhaps the most vulnerable group in the United States was elderly constituents. More than one-third were living in poverty, and fewer than one-half had health insurance.1,2 Democratic and Republican presidents, including Theodore Roosevelt, Franklin Roosevelt, and Lyndon Johnson, convinced Americans that there was a moral imperative for our country to care for its elderly.3–5 Through Social Security (enacted in 1935) and Medicare (enacted in 1965), a transformational shift in the well-being of seniors occurred.
The Patient Protection and Affordable Care Act and the Future of Child Health PolicyWith the United States Supreme Court’s landmark ruling in NFIB v Sebelius1 behind us, it is possible to attend to the full-scale implementation of the Affordable Care Act. The Act represents an unprecedented opportunity in child health policy, at least if those of us who in one way or another have immersed ourselves in child health make implementation a focus of our work. It would be naïve not to acknowledge the implementation challenges that lie ahead, conceptually, operationally, and politically, but working in a challenging environment hardly represents a new problem where improving child health is concerned.
Health Literacy and Health PolicyHealth literacy skills allow individuals to obtain, process, understand, and communicate information about health, as well as function in the health care system and make informed health decisions.1 Health literacy can also play an important role in successful implementation of health policies.2 Health literacy is therefore recognized as “…one of the top four national priorities for public health”,3 with health literacy research “becoming foundational in reforming health and health care in the United States”.
A History of the Academic Pediatric Association’s Public Policy and Advocacy InitiativesThroughout its 50-year history, the Academic Pediatric Association (APA) has recognized the importance of social, environmental, and public policy issues for children’s health. Since the organization’s inception, the APA and its members have taken an active interest in many major child health public policy initiatives (Table). APA members have worked to promote policies that benefit children’s health on a broad scale, conducting key research on health issues and health care interventions in order to inform policy debates, providing Congressional testimony, and leading initiatives for policy change.
Children With Special Health Care Needs: A Celebration of Success!This special issue of Academic Pediatrics represents a celebration. We honor the careers of several people, the leadership of the Maternal Child Health Bureau (MCHB), and the achievements of a large number of experts who have helped to improve health care for children with special health care needs (CSHCN). We acknowledge the lessons learned regarding the care of this population, and we recognize the challenges that remain. We celebrate these children and their families.
Historical Perspective on Family-Centered CarePartnerships between families and their children’s medical providers are essential to ensuring quality health care. Around the country, families partner with providers to make decisions about their individual children and to improve health care practices, programs, and policies that affect all children. Such partnerships have not always been the norm. Families of children and youth with special health care needs (CYSHCN) and visionary professional leaders have identified the effective elements of collaborative family provider relationships.
From My Head and My Heart: Improving Quality of Care for Children and Youth With Special Health Care NeedsIt is an enormous honor to speak on the subject of improving quality of care for children with chronic conditions at a symposium honoring Jim Perrin. Jim was my division chief and immediate supervisor in my first job after fellowship. The work that we started together—looking at variation in care and outcomes for children in Rochester, New Haven, and Boston—shaped my entire career, and Jim has continued to be a mentor, a colleague, and a friend since that time over 20 years ago.