America's Children in Brief: Key National Indicators of Well-Being, 2010
Health Care
Health care includes the prevention, treatment, and management of illness and the promotion of mental and physical well-being through services offered by health professionals. Effective health care is an important aspect of promoting good health. The following indicators include measures of access to health care (health insurance and usual source of care) and indicators of two types of health care utilization (oral health and childhood immunization).
Children with health insurance, whether public or private, are more likely than children without insurance to have a regular and accessible source of health care. In 2008, 90 percent of children had health insurance coverage at least some time during the year, up from 89 percent in 2007 (Figure 6). The number of children without coverage at any time during the year was 7.3 million (10 percent of all children).11 The percentage of children with public health insurance increased from 31 percent in 2007 to 33 percent in 2008.
In 2008, Hispanic children were less likely to have health insurance, compared with White, non-Hispanic or Black children.12 Specifically, 83 percent of Hispanic children were covered by health insurance at some time during the year, compared with 93 percent of White, non-Hispanic children and 89 percent of Black children.
Figure 6: Percentage of children ages 0–17 covered by health insurance at some time during the year by type of health insurance, 1987–2008
NOTE: Public health insurance for children consists primarily of Medicaid, but also includes Medicare, State Children's Health Insurance Programs (SCHIP), and CHAMPUS/Tricare, the health benefit program for members of the armed forces and their dependents. Estimates beginning in 1999 include follow-up questions to verify health insurance status. Children are considered to be covered by health insurance if they had public or private coverage any time during the year. The data from 1996 to 2004 have been revised since initially published. For more information, see http://www.census.gov/hhes/www/hlthins/data/usernote/index.html.
SOURCE: U.S. Census Bureau, unpublished tables from the Current Population Survey, Annual Social and Economic Supplements.
Having a usual source of care—a particular person or place a child goes for sick and preventive care—facilitates the timely and appropriate use of pediatric services.13 In 2008, 6 percent of children had no usual source of health care; this was similar to the percentage in 2007. Children who were uninsured were nearly 10 times more likely than those with private insurance to not have a usual source of care in 2008 (30 percent, compared with about 3 percent).
Dental caries (cavities) is the single most common chronic disease of childhood.14 The percentage of younger children (ages 5–11) with untreated dental caries declined to 20 percent in 2005–2008 from 27 percent in 1999–2004 (Figure 7). For older children (ages 12–17) the percentage declined to 12 percent in 2005–2008 from 19 percent in 1999–2004. In 2005–2008, the percentage of both younger and older children with untreated dental caries living below the poverty level was twice that of children in families with incomes at or above 200 percent of the poverty level. From 1999–2004 to 2005–2008 the percentage of children with untreated dental caries significantly declined for children living below the poverty level and for children in families with incomes at 100–199 percent of the poverty level.
Figure 7: Percentage of children ages 5–17 with untreated dental caries (cavities) by age and poverty status, 1988–1994, 1999–2004, and 2005–2008
SOURCE: National Center for Health Statistics, National Health and Nutrition Examination Survey.
Immunization coverage rates measure another aspect of health promotion—the extent to which children are being protected from vaccine-preventable diseases. In 2008, 76 percent of children ages 19–35 months received the recommended combined six-vaccine series (often referred to as the 4:3:1:3:3:1 combined series).15 Children in families living below the poverty level had a lower rate of coverage (72 percent) with the combined six-vaccine series than children in families living at or above the poverty level (78 percent).
The percentage of children ages 19–35 months who received the recommended four doses (or more) of pneumococcal conjugate vaccine (PCV) increased from 75 percent in 2007 to 80 percent in 2008. The Hepatitis A vaccine was universally recommended in 2006, and 40 percent of children ages 19–35 months received the recommended two doses (or more) of the vaccine in 2008.
11 DeNavas Walt, C., Proctor, B.D., and Smith, J.C. (2009, September). Income, poverty, and health insurance coverage in the United States: 2008 (Current Population Reports, P60-236[RV]). Washington, DC: U.S. Census Bureau. Retrieved from http://www.census.gov/prod/2009pubs/p60-236.pdf.
12 In this survey, respondents were asked to choose one or more races. All race groups discussed in this paragraph refer to people who indicated only one racial identity. Hispanic children may be of any race.
13 Foltin, G.L. (1995). Critical issues in urban emergency medical services for children. Pediatrics, 96 (1), 174–179.
14 Dye, B.A., Arevalo, O., and Vargas, C.M. (2010). Trends in paediatric caries by poverty status in the United States, 1988–1994 and 1999–2004. International Journal of Paediatric Dentistry, 20(2): 132–143.
15 The 4:3:1:3:3:1 series consists of 4 doses (or more) of diphtheria, tetanus toxoids, and pertussis (DTP) vaccines, diphtheria and tetanus toxoids (DT), or diphtheria, tetanus toxoids, and any acellular pertussis (DTaP) vaccines; 3 doses (or more) of poliovirus vaccines; 1 dose (or more) of any measles-containing vaccine; 3 doses (or more) of Haemophilus influenzae type b (Hib) vaccines; 3 doses (or more) of hepatitis B vaccines; and 1 dose (or more) of varicella vaccine. The collection of coverage rate estimates for this series began in 2002. The recommended immunization schedule for children is available at http://www.cdc.gov/vaccines/recs/schedules/child-schedule.htm#printable.