Annual report on access to and utilization of health care for children andyouth in the United States-2000

Objective.-This report provides an update on insurance coverage, use of hea lth care services, and health expenditures for children and youth in the Un ited States. In addition, the report provides information on variation in h ospitalizations for children from a new 22-state hospital discharge data so urce. Methods.-The data on insurance coverage, utilization, and expenditures come from the Medical Expenditure Panel Survey. The data on hospitalizations co me from the Database for Pediatric Studies, which is part of the Healthcare Cost and Utilization Project. Both data sets have been prepared by the Age ncy for Healthcare Research and Quality. Results.-Few changes in insurance coverage occurred between 1996 and 1998. About two thirds of American children are covered by private insurance and 19% by public sources; the remaining 15% are uninsured. Of the 71.5% of chi ldren who have at least I doctor's office visit, the average number of visi ts was 3.9, but this ranged from 2.7 among the uninsured to 4.2 for those w ith private insurance. Slightly more than half of children had a prescripti on, and these averaged 5.4 prescriptions. The majority of children (85%) in cur medical expenditures, averaging $1019 for children with any expenditure . Private health insurance was by far the largest payer of medical care exp enses for children, even more so than among the general population. However , nearly 21% of expenditures for children's health care were paid out of po cket by children's families. The data also show substantial differences in average length of hospitalization across states, ranging from 2.7 to 4.0 da ys, and rates of hospital admission through the emergency department, which vary across states from 9% to 23%. Injuries are a major reason for hospita lization, accounting for 1 in 6 hospital stays among 10- to 14-year-olds. I n the 10-17 age group, 1 in 7 hospital stays are due to mental disorders. A mong 15- to 17-year-olds, more than one third of all hospital stays are rel ated to childbirth and pregnancy. Conclusion.-Children's use of health care services varies considerably by w hat type of health insurance coverage they have. Expenditures for children entail a substantial out-of-pocket component, which may be quite large for children with major health problems and which may represent a significant b urden on lower-income families. Substantial variation in hospitalization ex its across states.