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Nearly 60 Percent of Child Health Care Costs for Uninsured Children Is Paid Out of Pocket

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Press Release Date: January 25, 2001

About 58 percent of health care costs were paid out-of-pocket for children who were uninsured throughout 1996 in the United States, according to a new report by the researchers at the Agency for Healthcare Research and Quality (AHRQ) and Harvard University. In comparison, about 23 percent was paid out-of-pocket for children who were covered by private health insurance. The average total expenditures for all health care services for uninsured children was $369, while the average total expenditures for children covered by private insurance was $1,100. The report was published as an article in the inaugural issue of Ambulatory Pediatrics.

This report is the second in a series of annual reports on access to and use of health care by children and youth in the United States. Other data in the report cover utilization of medical and dental services, insurance coverage and hospitalization. Well over half of all children had no dental visits in all of 1996 (57.5 percent), rising to over 70 percent for blacks and Hispanics and nearly 80 percent for the uninsured.

The data in the report come from AHRQ's Medical Expenditure Panel Survey (MEPS) and the Healthcare Cost and Utilization Project (HCUP) and its new database for pediatric studies. It provides national, regional, and, for the first time, state-specific findings on children's hospitalizations.

"This second report provides a clear picture of the state of children's health care in the United States and identifies gaps in the health care of America's young," said the Agency's deputy director, Lisa A. Simpson, M.B., B.Ch., F.A.A.P., and a co-author of the study. "The MEPS and HCUP data, enhanced by a new database for pediatric studies, are powerful tools for researchers, practitioners, policymakers and child health advocates in assessing the trends in children's health care."

"These results continue to underscore the differences in patterns of health care use by children compared to adults, and thus require separate attention," said Dr. Marie McCormick, M.D., ScD, of the Department of Maternal and Child Health at the Harvard School of Public Health, the lead author of the study.

The findings also show there was no change in the percent of children who were uninsured from the first six months of 1997 to the same period in 1998. However, the new report does not reflect the potential impact of the State Child Health Insurance Program (SCHIP) of 1997, which had only been partially implemented by mid-1998.

Diseases of the respiratory system and the digestive system and injuries and poisonings were the major reasons for hospitalization of children over one year of age. As was shown in the previous report, the most common reasons for hospitalization of infants are birth-related, while youths age 15-17 were hospitalized mostly for problems related to pregnancy and childbearing.

About 40 percent of all hospital stays for children ages 1-4, and 28 percent of those for children ages 5-9 are for respiratory conditions (such as bronchitis, pneumonia and asthma). For 10-14 year-olds, 17 percent are injury-related and 15 percent are for mental disorders. For youths ages 15-17, 38 percent of all stays are related to pregnancy and childbirth, 15 percent are injury-related and 13 percent are for mental disorders.

This issue of Ambulatory Pediatrics will also contain six other articles based on research sponsored by AHRQ. The entire issue can be found at The articles are:

  • Methodologic Challenges in Health Services Research in the Pediatric Population.
  • Methodologic Challenges in Developing and Implementing Measures of Quality for Child Health Care.
  • Evidence Syntheses in Child Health.
  • Methodologic Issues in Pediatric Outcomes Research.
  • Methodologic Issues in the Conduct and Interpretation of Pediatric Effectiveness Research.
  • A Comparison of Health Care Experiences for Medicaid and Commercially Enrolled Children in a Large Nonprofit HMO.

Copies of the Annual Report on Access to and Utilization of Health Care for Children and Youth in the United States—2000 will be available without charge from the AHRQ Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907; phone: (800) 358-9295.

Note to Editors:

For more information, please contact AHRQ Public Affairs, (301) 427-1364.


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