ensuring that their purchasing decisions reflect the specific needs of children as much as possible within the existing resources. In the committee's view, purchasers should take the initiative to request new child-appropriate products.

3. Nonfinancial barriers to care should be reduced through the provision of assistance with child care and transportation, through the provision of culturally appropriate services, and through the use of information technology.

Health insurance alone does not guarantee utilization of appropriate care. Studies have shown that logistical difficulties for parents, such as transportation and child care, differences in the racial, ethnic and cultural backgrounds of providers and parents, and parental health beliefs can affect children's access to care. For children who live in medically underserved urban and rural areas, the availability and proximity of providers can present barriers to access. Even with insurance, it can be difficult to obtain health care.

The committee believes that information technology holds extraordinary promise to improve access for children in underserved areas, as well as to improve clinical quality and efficiency of care and to increase the availability of clinical information for research. Although it has not been systematically studied, the application of information technology continues to increase in patient care, professional education, patient education, research, and administration.

Based on the available scientific evidence and current trends in the delivery of care, the committee believes that programmatic design and delivery system issues have a vital impact on access for children. In sum, three particular areas need to be addressed: logistical barriers, cultural barriers, and advances in the use of information technology.

4. Outreach and enrollment procedures and coordination efforts should be designed so that all programs achieve the highest enrollment possible, particularly when states offer multiple programs with different eligibility requirements.

Years of experience with Medicaid indicate that there are many reasons why children who are eligible for the program may not be enrolled. For example, parents or other caretakers may not be aware of the program, may not know they or their dependents are eligible, or may not want to accept public aid. Other parents have experienced difficulties in trying to enroll in the program, including denials of applications for procedural errors or incomplete information, or because of cultural factors such as the need for translation.

States designing and implementing new SCHIP programs have learned from these experiences and are improving their procedures. With the new children's health insurance programs and other initiatives, more efforts are being made to help parents learn about the different programs and make enrollment easier, including having common application forms and streamlining the application and enrollment process.

States also will need to improve their efforts to coordinate administration and data collection among Medicaid, SCHIP, Title V maternal and child health agencies, and other state and private programs involving children and families, especially low-income working families. More specifically, states should coordinate health insurance efforts with initiatives in maternal and child health, mental health and substance abuse treatment and prevention, education, disabilities, and other areas.

5. Information generated from children's health care and insurance programs should be designed to be useful in evaluating short-term trends and making program adjustments, and should be made widely available.



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