Children's Health Fund (CHF) is committed to improving the health of medically underserved children through quality care provided in a medical home setting. The medical home concept embodies a system of care that addresses the comprehensive health care needs of children. This model of care, which is coordinated by a primary care provider and includes access to pediatric subspecialists and other health care professionals, in conjunction with family and community, ensures healthy growth and optimal development of a child.
Unfortunately, there are numerous barriers to providing children with a medical home. CHF, through its experience in delivering of health care services to medically underserved children and families throughout the country, has identified key barriers to providing a medical home and developed strategic policy objectives to address these barriers. These barriers must be addressed through comprehensive health care reform, to ensure not just health insurance coverage but also access so that every child has a medical home.
The majority of Americans are covered by health insurance supplied by their employer. However, there remain 45 million uninsured, 8.1 million of whom are children and million who depend on public programs, including Medicaid and State Children's Health Insurance Program (SCHIP).
Recent trends show that private coverage is eroding, with 2.3 million fewer Americans covered by employer based coverage in 2006 than 2000 and as many as 13 million more not given the option of employer based coverage. Reauthorization of SCHIP in February 2009, may provide coverage for an additiional 4 million children. However, the deep recession is also causing more children to be uninsured.
The cost of coverage is rising for both employers and employees. Premiums, a person’s share of the cost of the health insurance policy, are rising. Co-payments for office visits and prescriptions are also on the rise. The average American worker pays 12% more for their health insurance than they did the year before, consuming more and more of the family budget.
Children's Health Fund is concerned not only with the uninsured, but the near insured and the under insured as well. Increasingly, middle class families are struggling to make ends meet and doctors’ appointments are one of the first sacrifices to be made. Health care reform must address this growing problem so that all Americans aren’t just insured, but don’t have to think twice about bringing their child to the doctor.
With much of the national debate on health care focused on insurance, it is important to realize that health insurance coverage does not equal health access. An insured child may live in an area designated as a Health Professional Shortage Area, meaning there is less than one provider for every 2000 persons needing care. Such designations also highlight shortages of dentists and mental health professionals.
Oftentimes, children on Medicaid are turned away from pediatric sub-specialists because there is a waiting list. These providers often cannot afford to see Medicaid patients based on historically low reimbursement rates and allots certain appointments for Medicaid children.
Transportation is often a significant barrier for children in both rural and urban areas. An appointment is only good if the child can get to the appointment.