Conclusions

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 policy option. The committee members agreed throughout their deliberations that the ultimate goal of these strategies is to provide access to coordinated, efficient, and effective health care for all American children, including children who have preventable illnesses and injuries, chronic conditions, or other special health care needs.

Based on a review of scientific evidence and analysis of current trends, the committee drew the following conclusions.

1. All children should have health insurance.

Children's access to health care depends on several financial and nonfinancial factors. Financial factors include insurance status (insured or uninsured); the nature and extent of insurance coverage, including cost-sharing requirements such as copayments and deductibles; family income; and the costs of care. Among many nonfinancial factors, the availability and proximity of providers; types of coverage accepted by providers; logistical difficulties in scheduling and transportation; racial, ethnic, and cultural backgrounds of providers and families; and parental health beliefs have been shown to influence access to care.

When compared with insured children, uninsured children are more likely to be sick as newborns, less likely to be immunized at appropriate ages, less likely to receive medical treatment when they are injured, and less likely to receive treatment for illnesses such as acute or recurrent earaches and asthma. Having analyzed the available evidence on financial and nonfinancial barriers to care, the committee concludes that children's health insurance status is the single most important influence in determining whether health care is accessible to children when they need it.

2. Public and private insurers should be encouraged to develop affordable products that address the specific needs of children, including children with chronic conditions and special health care needs.

As a matter of principle, the committee believes that all children should have appropriate access to coordinated, efficient, child-appropriate, and effective care, including generally accepted preventive services; acute care for short-term illnesses and injuries; ongoing care for children with chronic medical conditions; rehabilitative care, including allied health services, for children with disabilities; and care for children with special needs, such as speech disorders.

The committee recognizes that financial resources are not unlimited and that accountable purchasers and policymakers must set priorities in order to make reasoned and equitable decisions about spending. However, costs of treatment and coverage for children vary according to their health status and can be difficult to determine from the information available in the public domain.

There are many areas of disagreement and uncertainty about the specific services to which children should have access. Providers, parents, and insurers often have different attitudes and positions about which services are "essential" and what expenditures and sources of payment are reasonable. The limited scientific evidence and professional consensus do not clearly indicate which specific diagnostic tests, treatments, procedures, drugs, specialists, and other services should be available to children, any more than is the case for adults.

There is tremendous variability in the structure and scope of health care benefits for children according to the source and the type of insurance coverage. In the current health care system, employers, states, parents, and others who purchase coverage on behalf of children bear the responsibility for



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