Children living in states in New England and the Upper Midwest are more likely to have health insurance and to receive recommended medical care than are children in other parts of the United States, according to a new scorecard from the nonprofit organization.
In the report, “Securing a Healthy Future: The Commonwealth Fund State Scorecard of Child Health System Performance, 2011,” researchers report on 20 indicators for how the nation's health care system is performing for children, based on the most recent data available. The report ranks states on access and affordability, prevention, and treatment, the potential to lead healthy lives, and equity.
“Where children lives matters, and it shouldn't,” Cathy Schoen, Commonwealth Fund senior vice president and coauthor of the report, said in a press briefing.
Massachusetts and Iowa ranked first overall among the states; Massachusetts had the lowest rate (3.3%) of uninsured children under age 19 years. Vermont, Maine, and New Hampshire rounded out the five top-performing states overall. The rest of the top 10 consisted of Rhode Island, Hawaii, Minnesota, Connecticut, and North Dakota. These states had consistently good scores, the report noted, but no state finished in the top half for all indicators.
States in the South and Southwest were the worst performers, with Nevada, Mississippi, Arizona, Texas, and Florida achieving the lowest scores, according to the report.
But exceptions to these geographic trends were found. For example, while the Southern states were generally ranked lower, Alabama had a high insurance rate for children, with 94% of the children there insured. And North Carolina had the highest rate of developmental screening.
The report also found that many states have been taking advantage of funding from the federal government to expand insurance opportunities for children.
These actions helped to stabilize insurance rates for children even as many of their parents lost insurance coverage during the recent recession. Insurance coverage rates for parents declined in 41 states over the last decade, while coverage rates for children increased in 35 states during the same time period.
But going forward, expansion of coverage to the rest of the family will be important, according to the Commonwealth Fund. When parents also have insurance, they are more likely to bring their children in for needed medical care, Ms. Schoen said.
The report offers examples of innovative children's health programs that can be models for other states. “States, we hope, will learn from each other,” said Commonwealth Fund president Karen Davis.
For example, in Colorado, which ranked 20th overall on the scorecard, the nonprofit Colorado Children's Healthcare Access Program works with primary care practices to negotiate with Medicaid for enhanced payments for certain preventive services for children. The additional reimbursement makes it feasible for those practices to accept more children enrolled in Medicaid and the Children's Health Insurance Program, giving more low-income children access to a medical home.