America's Children

Health Insurance and Access to Care

Margaret Edmunds and Molly Joel Coye, Editors

Committee on Children, Health Insurance, and Access to Care

Division of Health Care Services, Institute of Medicine,

and

Board on Children, Youth, and Families, National Research Council and Institute of Medicine

NATIONAL ACADEMY PRESS
Washington, DC
1998



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page R1
America's Children Health Insurance and Access to Care Margaret Edmunds and Molly Joel Coye, Editors Committee on Children, Health Insurance, and Access to Care Division of Health Care Services, Institute of Medicine, and Board on Children, Youth, and Families, National Research Council and Institute of Medicine NATIONAL ACADEMY PRESS Washington, DC 1998

OCR for page R1
NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. This study was supported by the Robert Wood Johnson Foundation. The views presented in this report are those of the Institute of Medicine's Committee on Children, Health Insurance, and Access to Care and are not necessarily those of the funding organization. Additional copies of this report are available for sale from the National Academy Press, Box 285, 2101 Constitution Avenue, N.W., Washington, D.C. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP's on-line bookstore at http://www.nap.edu. Library of Congress Cataloging-in-Publication Data America's children : health insurance and access to care / Margaret Edmunds and Molly Joel Coye, Editors. p. cm. "Committee on Children, Health Insurance, and Access to Care Division of Health Care Services, Institute of Medicine, and Board on Children, Youth, and Families, National Research Council and Institute of Medicine." Includes bibliographical references and index. ISBN 0-309-06560-7 (pbk.) 1. Child health services—United States—Finance. 2. Health services accessibility—United States. 3. Insurance, Health—United States. 4. Medically uninsured persons—United States. I. Edmunds, Margaret. II. Coye, Molly Joel. III. Institute of Medicine. Committee on Children, Health Insurance, and Access to Care. IV. Board on Children, Youth, and Families (U.S.) RJ102 .A387 1998 362.1'9892'000973—ddc21 98-25491 Copyright 1998 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

OCR for page R1
COMMITTEE ON CHILDREN, HEALTH INSURANCE, AND ACCESS TO CARE MOLLY JOEL COYE (Chair),* Director, West Coast Office, The Lewin Group, San Francisco IRENE AGUILAR, Primary Care Physician, Westside Family Health Center, Denver BRIAN K. ATCHINSON, Second Vice President, Government Relations, UNUM, Portland, ME STEPHEN M. BOROWITZ, Associate Professor of Pediatrics, University of Virginia Health Sciences Center RICHARD BUCCIARELLI, Professor, Institute for Child Health Policy, and Associate Chair, Department of Pediatrics, University of Florida College of Medicine PETER BUDETTI, Professor of Health Services Management, Preventive Medicine and Law, and Director, Institute for Health Services Research and Policy Studies, Northwestern University THOMAS W. CHAPMAN, Senior Vice President for Network Development and Professor of Health Services Management and Policy, The George Washington University Medical Center MARGARET C. HEAGARTY,* Director of Pediatrics, Harlem Hospital Center, and Professor of Pediatrics, College of Physicians and Surgeons, Columbia University ROBERT B. HELMS, Resident Scholar, Director of Health Policy Studies, American Enterprise Institute, Washington, DC VELVET MILLER, Deputy Commissioner, New Jersey Department of Human Services, Trenton ARNOLD MILSTEIN, Managing Director, William M. Mercer, Inc., and Medical Director, Pacific Business Group on Health, San Francisco PAUL NEWACHECK, Professor of Health Policy and Pediatrics, Institute for Health Policy Studies and Department of Pediatrics, University of California at San Francisco DAVID S. WEINER, President and CEO, Children's Hospital, Boston STEVEN H. WOOLF, Fairfax Family Practice Center, and Clinical Professor, Department of Family Practice, Medical College of Virginia Institute of Medicine Staff MARGARET EDMUNDS, Study Director ELISE LIPOFF, Research Associate (March 1997 through June 1997) ANNICE HIRT, Research Assistant (March 1997 through September 1997) KATHLEEN NOLAN, Research Assistant (November 1997 through May 1998) TRACY MCKAY, Project Assistant JOHN BROTHERS, Graphics Consultant CARINA WEI-YEE FUNG, Student Intern MICHAEL DOMBECK, Student Intern *   Member, Institute of Medicine.

OCR for page R1
BOARD ON HEALTH CARE SERVICES INSTITUTE OF MEDICINE DON E. DETMER (Chair),* Senior Vice President, The University of Virginia STUART H. ALTMAN,* Sol C. Chaikin Professor of National Health Policy, The Florence Heller Graduate School for Social Policy, Brandeis University NANCY W. DICKEY, Private Practice, College Station, TX B. KEN GRAY, Corporate Medical Director, Metroplex Emergency Physician Associates, P.A., Dallas PAUL F. GRINER,* Vice President and Director, Center for the Assessment and Management of Change in Academic Medicine, Association of American Medical Colleges, Washington, DC BRENT C. JAMES, Executive Director, Institute for Health Care Delivery Research, and Vice President, Medical Research and Continuing Medical Education, Intermountain Health Care, Salt Lake City JACQUELINE KOSECOFF, President and Co-Chief Executive Officer, Value Health Sciences, Inc., Santa Monica SHEILA T. LEATHERMAN, Executive Vice President, Center for Health Care Policy and Evaluation, United Health Care Corporation, Minneapolis JOHN LUDDEN, Senior Vice President for Medical Affairs, Harvard Pilgrim Health Care, Brookline BARBARA J. McNEIL,* Ridley Watts Professor, Department of Health Care Policy, Harvard Medical School RUSSELL L. MILLER, Health Science Center, State University of New York at Brooklyn MILDRED MITCHELL-BATEMAN,* Clinical Director, Huntington Hospital, Huntington, WV MARY MUNDINGER,* Dean and Centennial Professor in Health Policy, Columbia University UWE E. REINHARDT,* James Madison Professor of Political Economy and Professor of Economics and Public Affairs, Princeton University MARY LEE SEIBERT, Acting Provost, Ithaca College GAIL L. WARDEN,* President and Chief Executive Officer, Henry Ford Health System, Detroit Institute of Medicine Staff CLYDE J. BEHNEY, Deputy Executive Officer and Director, Board on Health Care Services *   Member, Institute of Medicine.

OCR for page R1
BOARD ON CHILDREN, YOUTH, AND FAMILIES NATIONAL RESEARCH COUNCIL AND INSTITUTE OF MEDICINE JACK P. SHONKOFF (Chair), Professor and Dean, Heller Graduate School, Brandeis University DAVID V. B. BRITT, President-Chief Executive Officer, Children's Television Workshop, New York City LARRY BUMPASS, Professor of Sociology, Center for Demography and Ecology, University of Wisconsin-Madison FERNANDO A. GUERRA, Director of Health, San Antonio Metropolitan Health District BERNARD GUYER,* Professor and Chairman, Department of Maternal and Child Health, Johns Hopkins School of Hygiene and Public Health ALETHA C. HUSTON, Professor, Department of Human Ecology, University of Texas at Austin RENEE R. JENKINS, Professor and Chairman, Department of Pediatrics and Child Health, Howard University SARA McLANAHAN, Office of Population Research, Princeton University ROBERT MICHAEL, Professor, Harris Graduate School of Public Policy Studies, University of Chicago PAUL NEWACHECK, Professor of Health Policy, Institute for Health Policy Studies, and Department of Pediatrics, University of California at San Francisco MARTHA PHILLIPS, Executive Director, The Concord Coalition, Washington, DC JULIUS B. RICHMOND,* Professor of Health Policy, Emeritus, Department of Social Medicine, Harvard Medical School TIMOTHY M. SANDOS, Vice President, Education Division, ETC, Inc., Littleton, CO DEBORAH STIPEK, Professor of Education, Graduate School of Education, University of California at Los Angeles DIANA TAYLOR, Director, Women's Health Program, Department of Family Health Nursing, University of California at San Francisco GAIL WILENSKY,* Senior Fellow, Project Hope, Bethesda, MD National Research Council and Institute of Medicine Staff DEBORAH PHILLIPS, Executive Director, Board on Children, Youth, and Families *   Member, Institute of Medicine.

OCR for page R1
This page in the original is blank.

OCR for page R1
PREFACE The Committee on Children, Health Insurance, and Access to Care was asked by the Robert Wood Johnson Foundation to address a series of questions about health insurance for children. In addition to evaluating empirical evidence about the relationship between health insurance and access to care, the committee was asked to identify key trends in insurance coverage and in the delivery of care for uninsured children. The committee was asked to pay particular attention to changes in the provider community that might have an impact on access to care for uninsured and underserved children. The committee approached the study as an opportunity to evaluate the strengths and limitations of insurance as a means of improving children's health. From the beginning of their deliberations, the committee members took the position that several strategies potentially could increase the number of insured children and that their task was not to recommend one particular option. Rather, they decided to evaluate the advantages and disadvantages of a wide variety of approaches and to provide the best possible analysis of the various policies that might be considered, including some that have not yet been fully implemented or evaluated. The timing of the study brought special challenges. The committee held four meetings and a public workshop between March 1997 and January 1998. From the beginning of 1997, President Clinton and members of Congress debated a variety of proposals about insurance coverage for children, including Medicaid expansions, block grants, vouchers, tax credits, and several other strategies. In August 1997, Congress passed the Balanced Budget Act of 1997, enacting a new State Children's Health Insurance Program (SCHIP) with provisions for Medicaid expansions as well as market-based approaches to reducing the number of uninsured children. Because of the rapid rate of ongoing change in the health care system, particularly the increasing emphasis on Medicaid managed care, the committee intended for this report to present a general framework that would apply to several programs and strategies over time. The committee prepared a separate report entitled Systems of Accountability: Implementing Children's Health Insurance Programs, to focus on the evaluation of SCHIP and its impact. The committee included clinicians, researchers, policy analysts, and administrators. This consensus report reflects compromises made by committee members with differing views in order to reach language that each member of the committee could accept. For example, some committee members were willing to recommend universal, comprehensive coverage for all American children, while others were reluctant to do so because they felt it was beyond the scope of the study, or because they questioned the availability of resources, political will, or feasibility of comprehensive approaches. In the end, the

OCR for page R1
committee recommended that all children should have health insurance, but did not recommend a single set of benefits or a single source of financing. This report, then, is intended as an overview of key issues in the organization, delivery, and financing of health care for children. The audience for the report is intentionally quite broad. It includes the study's sponsor, the Robert Wood Johnson Foundation, as well as other philanthropic organizations; members of Congress, congressional staff, and federal agencies; governors, state legislatures, and state agencies; the public health community; providers and the many provider associations representing them; employers; health insurers; parents; and children's advocates. The committee hopes that this report will help a variety of policy makers and other decision makers to make more informed decisions about how to achieve their multiple—and often competing—objectives as the SCHIP program is implemented across the country. The committee hopes that over time its contribution will be useful in shedding light on the impact and possible consequences of choosing various policy options to expand health insurance coverage for children. MOLLY JOEL COYE CHAIR

OCR for page R1
ACKNOWLEDGMENTS The members of the Committee on Children, Health Insurance, and Access to Care and the study staff appreciate the assistance and contributions from many individuals and organizations during the course of the study. We express deep appreciation to all of the individuals and groups who contributed to the public workshop on June 2, 1997. Presentations were made by the following invited speakers: Maureen Ceidro, Julius Goepp, John Goodman, Jane Horvath, Dennis Johnson, Kay Johnson, Karen LaPlante, Charles LaVallee, John McDonough, Kim Monk, Diane Rowland, and Eugene Steuerle. Public statements were made by James Bentley, Stan Dorn, Steve Edwards, Samuel Flint, Shelly Gehshan, Catherine Hess, Ross Marine, and Kathleen Means. The committee and staff are particularly grateful to Patrick Chaulk and Carl J. Schramm, who served as moderators, and J. Michael McGinnis, who aptly summarized the day's proceedings. We also would like to thank the speakers who made invited presentations at the committee's first meeting in March 1997. They are Pamela Dickson, Burton Edelstein, Paul Fronstin, Dan Hawkins, Lawrence McAndrews, and Jacqueline Noyes. We particularly appreciate the contributions made by Paul Fronstin of the Employee Benefits Research Institute, who analyzed and provided data especially for this study and was responsive to numerous requests for additional information. We also thank Mark Hall of Wake Forest University's School of Law and Bowman Gray School of Medicine for providing a background paper and glossary on private insurance. Jane Koppelman's insightful and helpful comments on an earlier draft of the report are gratefully acknowledged. Michael Hayes, copy editor, also made many useful contributions and suggestions to improve the report. Thanks also go to Jane Andrews, Ellen Bayer, James Crall, Shelly Gehshan, Shirley Girouard, Suzanne Hansen, Dan Hawkins, Joan Henneberry, Robert Isman, Barbara Lamb, Marjorie Shofer, Marina Weiss, and Pete Wilson for providing technical comments on draft sections of the report. We are especially grateful to the members of the liaison panel for providing materials and public statements for the committee's consideration. The complete list of liaison panel members is included in Appendix D. Among those who were particularly active and helpful at various stages of the study are Sheila Avruch, Laura Camisa, Patrick Chaulk, Burton Edelstein, Donna Grossman, Elizabeth Hadley, Catherine Hess, Ed Howard, Ron Manderscheid, John McDonough, Kathleen Means, Ed Neuschler, and Eugene Steuerle. The committee could not have accomplished its tasks without the steadfast and creative efforts of

OCR for page R1
the Institute of Medicine staff, led by Margo Edmunds, the study director. Her thoughtfulness, foresight, and ingenuity in planning and managing the study were exemplary. Her efforts were supported by Elise Lipoff, research associate; Annice Hirt, research assistant; Kathleen Nolan, research assistant; Tracy McKay, project assistant; two summer interns, Carina Wei-Yee Fung and Michael Dombeck; and John Brothers, graphics consultant. Several members of the staff of the Institute of Medicine and National Research Council made contributions to this report. Clyde Behney developed the idea for the study with the sponsor and provided guidance throughout the project. Kenneth Shine, Karen Hein, and Deborah Phillips also made several helpful comments at several stages of the project. Others who made contributions are Drusilla Barnes, Sue Barron, Mona Brinegar, Claudia Carl, Margo Cullen, Molla Donaldson, Jane Durch, Mike Edington, Robert Epstein, Marilyn Field, Kay Harris, Roger Herdman, Carrie Ingalls, Jeff Isenhour, Jim Jensen, Patricia Kaiser, Linda Kilroy, Michele Kipke, Jeffrey Koshel, Karen Kreiger, Marion Ein Lewin, Cathy Liverman, Luis Nunez, Constance Pechura, Deborah Phillips, Barbara Kline Pope, Dan Quinn, Barbara Rice, Kristen Robinson, Evelyn Simeon, Mary Lee Schneiders, Sally Stanfield, Michael Stoto, Kathleen Stratton, and Gooloo Wunderlich. This report has been reviewed by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the authors and the IOM in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The content of the review comments and the draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their participation in the review process: John Bartkowski, Sixteenth Street Community Health Centers, Inc., Milwaukee, WI; Judith Feder, Georgetown University Institute for Health Care, Public Policy, and Research, Washington, DC; Julius Goepp, Division of Pediatric Emergency Medicine, University of Rochester School of Medicine, Rochester, NY; Bernard Guyer, Department of Maternal and Child Health, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD; Mark Hall, Wake Forest University School of Law and Bowman Gray School of Medicine, Winston-Salem, NC; and Melvin Worth, IOM Scholar in Residence. While the individuals listed above have provided many constructive comments and suggestions, responsibility for the final content of this report rests solely with the authoring committee and the IOM. The study was undertaken with the support of the Robert Wood Johnson Foundation. The contributions of Foundation staff members Pamela Dickson, senior program officer, Robert Hughes, vice president, and Judith Whang, program officer, are gratefully acknowledged.

OCR for page R1
CONTENTS Summary   1 Part I: Does Insurance Equal Access To Care?     1   Introduction And Overview   11     Purpose of This Study   13     The Policy Context   14     Conclusions   19     Organization of This Report   21     References   22 2   Health Insurance And Children In America   23     Background   23     Profile of Health Insurance Coverage   25     Demographics of Coverage for Children   27     Duration of Lack of Coverage   34     Regional Variations in Lack of Coverage   38     Summary and Discussion   41     References   42 3   Health Insurance And Access To Care   44     Why Access Matters   44     Financial Barriers to Access   44     Nonfinancial Barriers to Access   52     Access to What? Defining Necessary Health Services   55     Implications   56     References   62

OCR for page R1
Part II: Financing Health Care For Children     4   Safety Net Providers   67     Definition of Safety Net   67     Sources of Funding for Safety Net Providers   68     Disproportionate Share Hospital Payments   70     Community Health Centers   70     Children's Hospitals   72     Public Health Departments   75     School-Based Health Centers   79     Implications   79     References   80 5   Medicaid   81     History and Overview of the Medicaid Program   81     Eligibility   83     Access to Care   86     Scope of Services   90     Medicaid Managed Care   94     Impact of Recent Federal Legislation   96     Implications   99     References   100 6   State And Private Insurance Initiatives   102     Background   102     Designing Children's Insurance Programs   104     Profiles of State-Sponsored Programs   110     Private Programs   115     Summary and Implications   118     References   118 7   Children's Health Care Needs   120     Epidemiology of Illnesses in Children   121     Public Coverage for Special Health Care Needs   127     Financial Barriers Associated with Special Needs   129     Nonfinancial Barriers for Special Needs Children   129     Information Technology   133     Access Under Managed Care   133     Implications for Children's Insurance Expansions   136     References   137 Appendixes     A   Market-Based Approaches to Insurance Reform, by Robert B. Helms   143 B   Information for Accountability   155 C   Public Workshop Agenda and Participants   170 D   Members of Liaison Panel   177 E   Committee and Staff Biographies   185 Index   189

OCR for page R1
Boxes, Tables, and Figures Boxes 1.1   Highlights of the State Children's Health Insurance Program   13 1.2   Headlines in The New York Times: Children's Health Care Coverage, 1996-1997   15 1.3   Data and Information Reviewed for This Report   17 3.1   Benefits Recommended by the National Forum on the Future of Children and Families   58 3.2   U.S. Preventive Services Task Force Recommended Routine Preventive Services for Children (0-10 years)   59 3.3   American Academy of Pediatrics Recommended Health Care Services for Children and Adolescents   60 3.4   Services Allowed Under SCHIP   61 5.1   A Brief History of Medicaid Legislation Concerning Children   84 5.2   Medicaid Services   91 5.3   EPSDT Health Services Requirements   93 7.1   Supplemental Security Income Program   130 7.2   Caregivers' Time Costs   132 7.3   Scenarios Demonstrating Increased Access to Care via Information Technology   134 Tables 2.1   Trends in Health Insurance Coverage Among Children, Ages 0-17, United States, 1987-1995 (percent)   24 2.2   Trends in Health Insurance Coverage Among Adults, 1987-1995 (percent), Ages 18-64, United States, 1987-1998 (percent)   24 2.3   Trends in Health Insurance Coverage by Actual Numbers Among Children, Ages 0-17, United States, 1987-1995   26 2.4   Trends in Health Insurance Coverage Among Adults, Ages 18-64, United States, 1987-1995 (millions)   26 2.5   Federal Poverty Thresholds, by Size of Family, United States, 1995   38 2.6   Number and Percentage of Children Without Health Insurance Coverage, Ages 0-17 by Number of Consecutive Months Without Coverage, United States, 1992-1994   39 3.1   Hospitalizations for Ambulatory Care-Sensitive Conditions per 1,000 Children Under Age 5, by Area of Residence, United States, 1989   48 3.2   Urgent and Nonurgent Emergency Room Visits for Children Under Age 15, United States, 1995   51 3.3   Drivers of Health Care Dollars, United States, 1993   57 4.1   Sources and Amounts of Funding for Selected Safety Net Programs in Health Services, United States, 1992-1995   69 4.2   National Cost of Uncompensated Care for Registered Community Hospitals, United States, 1987-1995   71 4.3   Insurance Status of CHC Patients, United States, Selected Years, 1980-1995   73

OCR for page R1
4.4   CHC Federal Grant Funds and Number of Patients, United States, Selected Years, 1980-1995   74 4.5   Trends in Hospital Admissions, Length of Stay, and Percentage of Care Devoted to Low-Income Patients, Freestanding Children's Hospitals, United States, Selected Fiscal Years, 1990-1995   77 4.6   Percentage of City and County Health Departments Offering Selected Health Care Programs, United States, 1992-1993   78 5.1   Trends in Managed Care and Fee-for-Service Enrollment under Medicaid, United States, 1991-1996   95 5.2   Comparison of Prior Welfare Laws and the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193), United States   97 6.1   State Initiatives to Expand Coverage to Children (as of May 1997)   103 6.2   Eligibility Criteria for Programs Providing Health Care Coverage for Children (as of May 1996)   106 6.3   Scope of Benefits of Programs Providing Health Care for Children   109 6.4   Premium Subsidy Structure for State-Subsidized Insurance Programs   111 7.1   Children's Needs for Health Care, United States, 1992   121 7.2   Number of Acute Conditions Per 100 Persons Per Year, for Children and All Ages, United States, 1994   122 Figures 2.1   Trends in health insurance coverage among children, ages 0-17, United States, 1987-1995   28 2.2   Trends in health insurance coverage among adults, ages 18-64, United States, 1987-1995   28 2.3   Comparison of trends in health insurance coverage for adults, ages 18-64, and children, ages 0-17, United States, 1987-1995   29 2.4   Patterns of children's health insurance coverage by age, for employer-based insurance, Medicaid, and children without coverage, United States, 1995   30 2.5   Children's health insurance coverage within age groups, for employer-based insurance, Medicaid, and uninsured children, United States, 1995   31 2.6   Health insurance coverage among children by race and ethnicity, United States, 1995   32 2.7   Patterns of health insurance coverage among children by race and ethnicity, United States, 1995   33 2.8   Characteristics of families of children with employer-based insurance,ages 0-17, United States, 1995   35 2.9   Characteristics of families of children with Medicaid coverage, ages 0-17, United States, 1995   36 2.10   Characteristics of families of uninsured children, ages 0-17, United States, 1995   37 2.11   Percentage of children without health insurance coverage, ages 0-17, by number of consecutive months without coverage, United States, 1992-1994   39 2.12   Distribution of uninsured children by state, 1995   40 3.1   A framework for approaching financial and nonfinancial influences on access   45 3.2   Hospitalizations for ambulatory care-sensitive conditions per 1,000 children under age 5, United States, 1989   48

OCR for page R1
3.3   Vaccinations against selected diseases for children ages 19-35 months by poverty status, United States, 1994   49 3.4   Vaccinations of children ages 19-35 months for selected diseases, by race, United States, 1994   49 3.5   Urgent and nonurgent emergency room visits for children under age 15, United States, 1995   51 3.6   Drivers of health care dollars, United States, 1993   57 4.1   National cost of uncompensated care in registered community hospitals, United States, 1987-1995   71 4.2   CHC patients by payer source, United States, selected years, 1980-1995   73 4.3   CHC federal grant funds and number of patients, United States, selected years, 1980-1995   74 4.4   Percentage of revenues from public and private sources for children'shospitals, United States, 1995   76 4.5   Average gross revenue per freestanding acute-care children's hospital, United States, 1991-1995   76 4.6   Sources and percentages of funding for local health departments, United States, 1992-1993   78 5.1   Medicaid beneficiaries and expenditures, by enrollment group, United States, 1995   82 5.2   Trends in the number of Medicaid recipients, by enrollment group, United States, 1987-1995   82 5.3   State Medicaid expenditures as a percentage of total state expenditures, by fiscal year, United States, 1987-1996   86 5.4   Trends in the number of dependent children ages 0-21 years receiving Medicaid, United States, 1980-1995   87 5.5   Trends in the average annual cost per dependent child receiving Medicaid, United States, 1980-1995   87 5.6   Percentage of Medicaid recipients enrolled in fee-for-service and managed care plans, United States, 1991-1996   95 7.1   Number of children ages 0-17 with selected chronic conditions, United States   124

OCR for page R1
This page in the original is blank.

OCR for page R1
America's Children

OCR for page R1
This page in the original is blank.