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New report provides an overview of children's insurance coverage, health care use and expenditures, and quality of care

American children's use of health care services varies dramatically by the type of health insurance they have, their race/ethnicity, and family income. The quality of care they receive, based on parent reports, also varies by type of coverage. In addition, children's use of hospital services varies substantially across States and by age. These and other findings about U.S. children's health care and insurance coverage are presented in a recent report compiled by Anne Elixhauser, Ph.D., and colleagues at the Agency for Healthcare Research and Quality and the Harvard School of Public Health.

The report reveals that in 2000, 65 percent of children birth to age 17 were privately insured, 22 percent were insured through public sources, and 14 percent were uninsured. Children without health insurance coverage were less likely to use health care services, and when they did, their rates of use and expenditures were lower than insured children. Publicly insured children were the most likely to use hospital inpatient and emergency department care. Children who were black, Hispanic, or lived in very poor families had lower health care use and expenditures. About 80 percent of all children's health care expenditures were attributed to the 20 percent of children who spent the most for health care services. Although most parents believed the care their children received was good, care quality varied significantly by type of insurance coverage.

There were significant differences across States in the experiences of hospitalized children. Average length of hospitalization across the United States ranged from 2.9 to 4.1 days, and rates of hospital admission through the ED varied across States from 10 to 25 percent. Over half (54.5 percent) of children's hospital stays were paid by private insurance, 37 percent were billed to Medicaid, and 5 percent of stays were uninsured. Reasons for admission varied by age. Respiratory conditions were the most frequent diagnoses for 1-9 year olds, injuries were most frequent for 10-14 year olds, and pregnancy was the most common reason for admission for 15-17 year olds. Mental disorders accounted for over one in seven stays among 10-17 year olds.

The researchers used data from the Medical Expenditure Panel Survey (MEPS), an ongoing, nationally representative survey of medical care use and expenditures, and the Nationwide Inpatient Sample and the State Inpatient Databases, which are part of the Healthcare Cost and Utilization Project. Both data sets are maintained by AHRQ.

More details are in "Health care for children and youth in the United States: 2001 annual report on access, utilization, quality, and expenditures," by Dr. Elixhauser, Steven R. Machlin, M.S., Marc W. Zodet, M.S., and others, in the November 2002 Ambulatory Pediatrics 2(6), pp. 419-437.

Reprints (AHRQ Publication No. 03-R015) are available from the AHRQ Publications Clearinghouse.

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