Toward a national child health policy

Article Abstract:

Unfortunately, factors that determine access to medical care for children in the United States involve parental income, age of the child, where the family lives, and which organ or organs are affected. The only other country in the developed world where this is true is South Africa: all other nations provide their children with health insurance. In the US preventive health care services are inequitable, with substantial regional variation. The financing system for child health care currently involves more than 35 health programs in 16 different agencies. Some sick children do not fit into any of the funded disease, age, family means, or geographical categories. State health organizations are equally complex. Furthermore, although the pay-off for prenatal care in terms of dollars saved in newborn intensive care is well known, 14 million women of childbearing age have no maternity care coverage. Immunization saves lives and prevents diseases that require expensive treatment, yet immunization programs are declining, because government and insurance coverage have not increased in step with the cost of vaccine. Between 12 and 14 million children under the age of 21 are uninsured, and many children with insurance are not insured for preventive and outpatient care. Our system of child health care is inequitable, inefficient, and wasteful. The goal of any system should be to allow children to develop to their maximum potential in an environment that is safe, healthful, and nurturing. For this, an appropriate administrative structure is needed. An Assistant for Child Health should be established in the Department of Health and Human Services, as well as a child health advocate in the Office of Domestic Affairs. A committee within each congressional house could have jurisdiction over child health. All children need financial access to health care. The American Academy of Pediatrics has a financial plan to provide access for all children through the age of 21, and for pregnant women. Employer-based insurance, private insurance, Medicaid, insurance premiums, and an employer payroll tax for employers who do not cover children and pregnant women, would all provide funds. Ultimately, an effective child health plan benefits all people. (Consumer Summary produced by Reliance Medical Information, Inc.)

Economic aspects, Maternal and infant welfare, Infant welfare, Maternal welfare, Child health services, editorial

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A proposal to provide health insurance to all children and all pregnant women

Article Abstract:

There are now 33 million people without health insurance in the US, including as many as 12 million children, the majority of whom are white and living with two parents, at least one of whom works. Even more children are underinsured, without funds to pay for preventive care and care for acute illness. More than 14 million women of childbearing age have inadequate or no maternity coverage; those without coverage do not obtain prenatal care and bear a disproportionately large number of infants who die. Most Americans support the idea of universal access to health care, but without, however, detailing the mechanisms by which this should come about. One proposal, made by the American Academy of Pediatrics (AAP), that would provide health insurance to all children and pregnant women is presented. Such care should be comprehensive and preventive, with its quality ensured. Medicaid (a program for people at certain income levels) should be replaced by a single-tier program. Insurance programs should be administered at the state level and should prevent the possibility of medical expenses' becoming a financial burden for families. Choices for both patients (which doctor to visit) and physicians (which patients to treat) should be possible. The details of the AAP plan are sketched out. It divides benefits into preventive care, primary and major medical care, and coordinated care. Cost-sharing is built in, with copayment by patients according to their income levels. The roles of employers and the state in providing funds are discussed. The AAP believes this proposal is the first step toward providing health insurance for all Americans. It was drafted after extensive consultation with organizations representing a range of health, pediatric, legislative, and business interests. The AAP intends to introduce legislation supporting its proposal in 1991. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Children, Pregnant women, Health insurance, Insurance, American Academy of Pediatrics

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Organ Transplantation-Barriers, Outcomes, and Evolving Policies

Article Abstract:

Organ transplantation has significantly improved the prognosis of patients with kidney failure, liver disease, and other life-threatening conditions. Kidney transplant patients live significantly longer than patients on long-term dialysis. The United Network for Organ Sharing (UNOS) coordinates the distribution of organs to maximize their therapeutic value. The transplant community struggles with regional versus nationwide distribution; equitable transplantation independent of race, economic status, or region, and other challenges. Efforts to give the sickest patients first access to organs may prevent the patients with the best prognosis from receiving curative care.

Editorial, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation, United Network for Organ Sharing

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