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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health
there are no clear denominators and the unreliability of coding are serious. In the first case, there is no way of knowing how to interpret rates of diagnoses, since the population is not stable over time, with people going in and out of practices and plans. In the second, there are obstacles to overcome in order to ensure that coding is consistent. Of concern is the bias frequently introduced by the requirements for reimbursement of medical services, which often influences the ways in which diagnoses are reported. Another limitation is that some sites or plans, especially managed care plans, do not collect data on patients but, rather, on visits. Other concerns relate to how issues of cultural mistrust, perceived racism, or stereotyping may introduce measurement errors when providers and patients are from different cultural, ethnic, and racial backgrounds. Some of these latter problems exist in survey data as well.
State and Local Approaches
At the state and local levels, the measurement of children’s health has been even more variable. Other than infant mortality and other mandated perinatal indicators that are collected as part of national vital statistics, as well as the recent SLAITS surveys that have sufficient power to allow state estimates, state and local data collection is inconsistent across jurisdictions. In 1998 ASPE, in collaboration with the Administration for Children and Families and the David and Lucile Packard Foundation, implemented a state-level initiative to build on the work of the Federal Inter-Agency Forum on Child and Family Statistics. This initiative funded 14 states over a 2-year period to develop and track various state-level indicators of children’s health and well-being and “to institutionalize the use of indicators in state and local policymaking” (http://aspe.hhs.gov/hsp/cyp/childind98, accessed February 25, 2003).
Federally required reporting largely reflects categorical program funding, which often relies on measures of service utilization as proxy measures of health and is driven by funding allocation rather than a well-developed strategy to measure the health of children. In the past decade, some of that has begun to change due to new initiatives originating at the federal and local levels. First, the federal MCHB now requires that all states develop indicators of program performance and measures of the health of mothers and children as a requirement of receiving maternal and child health funding. With a specified set of indicators, states are now collecting and aggregating data on child and family health issues, but there is considerable latitude in how these indicators are measured and hence a lack of standardization. In many states, the demand for indicators has also trickled down to the local level. This move to require a common set of indicators may ultimately form the basis for a common set of metrics on children’s health across states.
CityMatCH, a national organization of local maternal and child health agencies, also has facilitated the enhanced collection and reporting of local maternal and child health data. For example, CityMatCH provides city-specific data re-