Clinical Care

In a 2022 survey, 59%

of women in the U.S. reported that they would not be able to pay an unexpected $500 medical bill in full without going into debt, and among those, 19% would be unable to pay it at all.⁶⁰ Widespread lack of access to affordable, timely and high-quality primary care is associated with increased preventable hospitalizations

, excess strain on emergency services

and missed opportunities to prevent

disease and manage

chronic conditions, all of which can lead to worse and more expensive health outcomes.^61–64

Changes over time. Nationally, the percentage of women ages 18-44 who reported a time in the past 12 months when they needed to see a doctor but could not because of cost increased 19%, from 14.6% to 17.4% between 2021 and 2022-2023. In 2022-2023, more than 10 million women were unable to afford care due to cost, representing an increase of 1.9 million women from 2021. 

Between 2021 and 2022-2023, the percentage of women who could not afford care due to cost increased:

During this time frame, the prevalence of avoiding care due to cost increased 76% in the District of Columbia (6.6% to 11.6%), 48% in New Jersey (11.7% to 17.3%), 39% in New York (10.0% to 13.9%), 37% in Washington (11.0% to 15.1%) and 26% in Colorado (13.9% to 17.5%). 

Differences. The prevalence of avoiding care due to cost varied significantly by household income, geography, disability status, educational attainment, race/ethnicity, sexual orientation and age in 2022-2023. The prevalence was:

Attention-deficit/hyperactivity disorder

(ADHD) is one of the most common neurobehavioral disorders in childhood.⁶⁵ (The term ADD is no longer an official diagnosis and is part of ADHD.) It is important to diagnose and treat ADHD early

.⁶⁶ ADHD cannot be cured, but it can be managed and symptoms may improve as children age. If left untreated, ADHD can lead to significant problems

in education, employment and personal relationships.⁶⁷

Changes over time. Nationally, the percentage of children ages 3-17 who had ADD or ADHD, were taking medication and had received behavioral treatment increased 21%, from 2.8% to 3.4% between 2021-2022 and 2023-2024. In 2023-2024, nearly 2.1 million children had ADD/ADHD, were taking medication and had received behavioral treatment, an increase of 340,900 compared with 2021-2022.

Between 2021-2022 and 2023-2024, ADD/ADHD treatment significantly increased 30% among children with a caregiver who graduated from college (2.7% to 3.5%).

During the same time period, ADD/ADHD treatment increased 129% in Oregon (2.4% to 5.5%) and 90% in Illinois (2.1% to 4.0%).

Differences. ADD/ADHD treatment among children significantly varied by race/ethnicity, geography, caregiver educational attainment and gender in 2023-2024. The prevalence was:

Maintaining continuous and adequate insurance

is essential for everyone, and especially children, since there is rapid growth in the first months and years of life.⁶⁸ When compared with children who have health insurance, uninsured children experience more health disadvantages, including lower rates of vaccine coverage

, more hospitalizations and

higher in-hospital mortality rates

.^69–71

Changes over time. Nationally, the percentage of children younger than 19 years not covered by private or public health insurance increased 6%, from 5.1% to 5.4% between 2022 and 2023.

During this time frame, the percentage of uninsured children significantly increased 55% in New Mexico (3.8% to 5.9%), 30% in South Carolina (4.7% to 6.1%) and 9% in Texas (10.9% to 11.9%).

Differences. The prevalence of uninsured children was 7.9 times higher in Texas (11.9%) than in Massachusetts (1.5%) in 2023. 

Early childhood immunizations are a safe and cost-effective way to protect children from potentially life-threatening preventable diseases

during their most vulnerable years.⁷²  

Changes over time. Nationally, the percentage of children who received all recommended doses of the combined seven-vaccine series by age 24 months decreased 4%, from 70.0% to 66.9% between the 2017-2018 and 2020-2021 birth cohorts.

During this time frame, childhood immunization rates significantly decreased 21% in Nebraska (77.3% to 61.2%) and 13% in Pennsylvania (76.7% to 67.1%).

Differences. The childhood immunization rate was 1.4 times higher in Massachusetts (83.1%) than in Montana (57.8%) in 2020-2021 birth cohorts.

The flu vaccine

helps protect people against seasonal influenza viruses (known as the flu) that may lead to severe complications.⁷³ Estimates suggest that during the 2022-2023 flu season, vaccines prevented

6 million flu-related illnesses and 65,000 hospitalizations associated with influenza in the U.S.⁷⁴

Changes over time. Nationally, the percentage of women ages 18-44 who reported receiving a seasonal flu vaccine in the past 12 months decreased 9%, from 38.9% to 35.5% between 2020-2021 and 2022-2023. This remains below the Healthy People 2030 target of 70.0%

of people age 6 months and older.⁷⁵ In 2022-2023, nearly 18.2 million women received a flu vaccine. 

Between 2020-2021 and 2022-2023, the prevalence of flu vaccination significantly decreased:

During this time frame, flu vaccination significantly decreased in 15 states. The largest decreases were: 27% in South Dakota (54.7% to 40.0%), 25% in Florida (30.3% to 22.7%) and 22% in Montana (41.5% to 32.2%).

Differences. Flu vaccination rates varied significantly by geography, educational attainment, race/ethnicity, household income, disability status, veteran status, age and sexual orientation. In 2022-2023, the prevalence was:

Annual health exams

provide an opportunity for women to access preventive services such as vaccines and screening tests

, which can help identify cancers and other conditions at an earlier stage when they are easier to treat.^76,77 Well-woman visits are also a great opportunity to discuss strategies

for minimizing health risks and achieving a healthy lifestyle.⁷⁸

Changes over time. Nationally, the percentage of women ages 18-44 who had a preventive medical visit in the past year increased 3%, from 70.5% to 72.7% between 2020-2021 and 2022-2023. In 2022-2023, 41.2 million women received a preventive visit. 

Between 2020-2021 and 2022-2023, the prevalence of well-woman visits significantly increased:

During this time frame, well-woman visits significantly increased in seven states. The largest increases were: 16% in Vermont (64.7% to 74.9%), 14% in California (62.4% to 71.3%) and 11% in Alaska (63.9% to 70.7%).

Differences. Well-woman visits varied significantly by geography, race/ethnicity, educational attainment, disability status, age, household income, sexual orientation and veteran status in 2022-2023. The prevalence was:

Nationally, the percentage of women ages 18-44 who reported having a personal doctor or health care provider decreased 2%, from 79.2% to 77.4% between 2021 and 2022-2023. This means roughly 403,800 fewer women had a personal doctor. During this period, the prevalence significantly decreased 8% in Nebraska (83.7% to 77.3%), South Carolina (79.2% to 72.8%) and Wisconsin (89.3% to 81.8%); and 7% in Iowa (86.5% to 80.3%). It also decreased 26% among women with an annual household income less than $25,000 (88.9% to 65.5%), 7% among Hispanic women (68.2% to 63.7%) and 5% among women ages 18-24 (75.4% to 71.6%). In contrast, the prevalence significantly increased 10% in Oregon (74.6% to 82.2%), 9% among women with incomes of $50,000-$74,999 (75.9% to 82.9%), 8% among women with incomes of $25,000-$49,999 (71.3% to 77.1%) and 4% among women with incomes of $75,000 or more (84.9% to 88.4%). Roughly 1.3 times more women in the highest income group (household incomes of $75,000 or more) had dedicated healthcare providers compared with the lowest income group (household income less than $25,000).

The American Academy of Pediatrics recommends

that all infants, toddlers and children receive routine preventive visits, known as well-child visits.⁷⁹ Younger children require more frequent

visits due to their rapid development.⁸⁰ As they enter adolescence, they experience several transitions that may require unique health care solutions and conversations. Social factors and behaviors that lead to morbidity and mortality are often initiated in adolescence

, which makes it a critical time for education, prevention and early intervention.⁸¹

Changes over time. Nationally, the percentage of children ages 0-17 who received one or more preventive visits in the past 12 months increased 4%, from 76.8% to 79.6% between 2021-2022 and 2023-2024. In 2023-2024, 57.1 million children received a preventive visit, nearly 1.5 million more than in 2021-2022. 

Between 2021-2022 and 2023-2024, the prevalence of well-child visits significantly increased:

During this time frame, well-child visits significantly increased in six states. The largest increases were: 11% in New Mexico (69.8% to 77.5%), 10% in Vermont (83.8% to 92.0%) and 9% in California (68.4% to 74.8%).

Differences. Well-child visits varied significantly by educational attainment, race/ethnicity, geography, age and special health care needs status in 2023-2024. The prevalence was:

Low-risk cesarean delivery and adequate prenatal care continued to fall short of 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 — slightly increased from 26.3% in 2022 to 26.6% in 2023, exceeding the Healthy People 2030 target of 23.6%

.⁸² 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 75.2% in 2023, short of the Healthy People 2030 target of 80.5%

of pregnant females who received early and adequate prenatal care.⁸³