Clinical Care

Health insurance coverage

promotes positive health outcomes, increases appropriate use of health care services and offers financial protection against high medical expenses. People without insurance are more likely to delay or forgo

necessary medical care because of cost and are less likely to have seen a doctor in the past year compared with people with insurance. Those without insurance often rely on emergency departments

to receive care, which costs more and is less efficient than preventive care.

Changes over time. Nationally, the percentage of women ages 19-44 not covered by private or public health insurance decreased 8%, from 11.8% to 10.9% between 2021 and 2022. In 2022, nearly 6.2 million American women did not have health insurance, 482,000 fewer women than in 2021. The uninsured rate among women decreased in nine states, led by: 30% in South Dakota (14.7% to 10.3%), 20% in Oklahoma (20.5% to 16.3%) and 17% in Ohio (8.4% to 7.0%).

Nationally, the percentage of children younger than 19 not covered by private or public health insurance decreased 6% from 5.4% to 5.1% between 2021 and 2022. The uninsured rate among children decreased 41% in New Mexico (6.4% to 3.8%).

Disparities. The percentage of uninsured women and children significantly varied by geography in 2022. The percentage of uninsured women was 8.5 times higher in Texas (23.0%) than in Massachusetts and the District of Columbia (both 2.7%). The percentage of uninsured children was 7.3 times higher in Texas (10.9%) than Massachusetts (1.5%).

There is currently a shortage

of pediatric specialists — such as those who specialize in developmental pediatrics or child psychiatry — in the U.S., and the uneven geographical distribution of pediatricians and family physicians has left many rural communities and other underserved areas

with insufficient child health care options. In addition to treating illnesses, pediatricians monitor childhood development and provide crucial preventive care

, including administering vaccinations

and tracking development, through wellness exams.

Changes over time. Nationally, the number of pediatricians increased 4%, from 109.3 to 113.2 per 100,000 children ages 0-21 between September 2022 and September 2023. In September 2023, there were approximately 100,000 pediatricians in the U.S., an increase of almost 3,000 pediatricians since September 2022. Twenty-five states and the District of Columbia had increases greater than or equal to the national change, led by: 7% in both South Dakota (73.6 to 78.5 per 100,000 children ages 0-21) and Arkansas (78.0 to 83.7), and 6% in both Wisconsin (102.9 to 108.8) and Nevada (59.4 to 62.7).

Disparities. The number of pediatricians per 100,000 children varied by geography. The rate was 4.7 times higher in Massachusetts (221.0 per 100,000 children ages 0-21) than Idaho (46.9).

Low-risk cesarean delivery and adequate prenatal care did not improve between 2021 and 2022 and have not met national public health goals. Low-risk cesarean delivery — the percentage of singleton, head-first, term (37 or more weeks) first births that were cesarean deliveries — remained at 26.3% in both 2021 and 2022, exceeding the Healthy People 2030 target of 23.6%

. Meanwhile, adequate prenatal care — the percentage of live births in which the mother received appropriate prenatal care in the first four months of pregnancy — was 74.9% in 2022, short of the Healthy People 2030 target of 80.5%

.

While the percentage of well-woman visits did not change significantly between 2019-2020 and 2021-2022, the most recent prevalence was significantly higher than it was in 2013-2014, representing an improvement over time.