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Adequate Health Insurance, 2019 Health Of Women And Children Report
Measure: Adequate Health Insurance, 2019 Health Of Women And Children Report

Why does this matter?

Health insurance is a critical factor in ensuring children receive the medical and preventive care they need to achieve and maintain good health. There is vast evidence documenting the benefits of insurance coverage for children's access to and utilization of care and the associated improvements in health outcomes.

There are three categories of health insurance coverage:

  1. Adequate insurance coverage: The Child and Adolescent Health Measurement Initiative measures health insurance adequacy through 1) coverage of needed services, 2) choice of providers and 3) reasonable coverage of costs.
  2. Inadequate insurance coverage or underinsurance: There is no standardized definition or consensus on how to measure this population. Various definitions include discontinuity in coverage, the exclusion of certain benefits in plans such as immunizations, and measures related to out-of-pocket costs and affordability. Varying definitions result in varying estimates of prevalence, making it a challenge to grasp the true magnitude of the problem of underinsurance.
  3. Lack of insurance coverage or uninsured: This population is also considered to have inadequate insurance coverage.

Tremendous effort has been devoted to reducing the number of uninsured children in the United States, but considerably less attention has been paid to the problem of underinsurance. Underinsurance among children is more common than lack of insurance — in 2016, 24.6 percent of U.S. children were underinsured, while 6 percent were uninsured children.

Compared with adequately insured children, those who are underinsured have more health disadvantages including:

  • Delayed or forgone care
  • Lack of a primary care doctor
  • Difficulty obtaining needed specialist care
  • Difficulty receiving needed referrals, care coordination and family-centered care

Underinsurance leaves a family unprotected from the financial risk of illness or disease. The family whose insurance has a high deductible or low coverage might face bankruptcy.

Source:
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Children with Health Insurance, 2019 Health Of Women And Children Report
Measure: Children With Health Insurance, 2019 Health Of Women And Children Report

Why does this matter?

Health insurance is a critical factor in ensuring children receive the preventive and acute medical care they need to achieve and maintain good health. Benefits of health insurance coverage include:

  • Improved access and use of preventive, primary and specialty health care
  • Improved quality of health care
  • Improved health outcomes

Children with health insurance had higher odds of having a medical home, the standard for providing high quality pediatric care. Children with private health insurance had  2.5 times the odds of reporting having a medical home and children with public insurance had 1.3 times the odds of reporting having a medical home compared with uninsured children. When compared with privately insured children, uninsured children have more health disadvantages including:

  • Unmet need for medical or dental care
  • Greater severity of illness, more hospitalizations and higher mortality rates
  • More vaccine-preventable disease
  • Higher rates of chronic illness such as asthma and diabetes

According to the National Center for Health Statistics, about 1 in 20 children ages 0-17 were uninsured at the time of interview in 2018. Among children ages 0-17 that had insurance, 54.7 percent had coverage through private plans and 41.8 percent had coverage through public plans (i.e. Medicaid, Children’s Health Insurance Program, state-sponsored or other government-sponsored health plans). The percent of uninsured children has declined steadily since 1997 when nearly 14 percent of children were uninsured.

Source:
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Homeless Family Households, 2019 Health Of Women And Children Report
Measure: Homeless Family Households, 2019 Health Of Women And Children Report

Why does this matter?

Housing is an important social determinant of health; substandard housing and homelessness are associated with a wide range of adverse health conditions, resulting in progressive morbidity and premature mortality. People who are homeless are more likely to face extreme poverty compared to those who are housed, which can make obtaining employment and accessing health services more difficult.

Severe health problems are common among homeless families. Some health problems contribute to homelessness, others are consequences of homelessness and sometimes homelessness complicates the treatment of illness. Knowing exactly where a condition falls in this spectrum is difficult to identify, however, homelessness is generally associated with higher rates of:

  • Mental illness and substance use: Many people that are homeless have a mental illness such as post traumatic stress disorder, schizophrenia or a substance use disorder. An estimated 26 percent of people that are homeless and in a shelter have a serious mental illness.  Substance use disorder and overdose disproportionately affect people who are homeless.
  • Physical, sexual, and emotional abuse: People that are homeless are at higher risk of being physically or emotionally abused.
  • Infections: People that are homeless are more susceptible to ear and upper respiratory infections, lice, scabies, influenza, hepatitis, sexually transmitted infections and pneumonia
  • Chronic illness: People that are homeless may develop or have a harder time treating chronic conditions such as malnutrition, dental caries, asthma, diabetes or hypertension.

National homelessness estimates vary substantially as it is difficult to accurately assess. A report by the National Alliance to End Homelessness estimated that on a given night in 2018, there were 552,830 people experiencing homelessness. This included 180,413 individuals in families, representing 33 percent of all people experiencing homelessness. Additionally, 7 percent of the homeless population was made up of unaccompanied children and youth.

Source:
  • U.S. Department of Housing and Urban Development, Annual Homeless Assessment Report, 2018



Water Fluoridation, 2019 Health Of Women And Children Report
Measure: Water Fluoridation, 2019 Health Of Women And Children Report

Why does this matter?

Community water fluoridation, the addition of an optimal amount of fluoride to a public water supply, is an effective way of preventing tooth decay in children and adults. Tooth decay, called dental caries by medical professionals, is the result of bacteria dissolving the enamel of a tooth. Dental caries are the most common chronic disease in children and can lead to:

  • Bacterial infections of the tooth root
  • Tooth extraction
  • Bacterial infections in the rest of the body
  • Pain, which can lead to decreased productivity and quality of life

Children with dental caries have nearly three times the odds of missing school due to dental pain compared with children with good oral health and, on average, have poorer school performance. Children and populations with low socioeconomic status have a higher prevalence of dental caries yet have barriers to accessing dental care, and less frequently have private dental insurance. Community water fluoridation is one of the primary methods of addressing this disparity. Fluoride inhibits mineral loss and enhances remineralization in tooth enamel, and also inhibits bacterial activity in dental plaque.

Source:
  • CDC, Water Fluoridation Reporting System, 2014

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