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Financing and Utilization

 

Health Services Financing and Utilization 

This section presents data on the health insurance status and utilization of health services among children. These statistics are summarized by source of payment, type of care, and place of service delivery.

Health Care Insurance Coverage 

Children receive health coverage through a number of sources, including private insurance, either through employers or purchased directly, or through public programs, such as Medicaid or the Children’s Health Insurance Program (CHIP). Eligibility for public programs is based on a family’s income, size and other requirements, such as citizenship or immigrant status. Every state has a CHIP program that helps to expand coverage to children who would otherwise be uninsured. Despite the progress achieved through public programs, approximately 6.5 million children remain uninsured in the United States. This section presents data on the health insurance status and utilization of health services within the child population. Data are summarized by source of payment, type of care, and place of service delivery where appropriate and feasible. Health insurance is critical for ensuring the health and well-being of children in the United States. Without health insurance coverage, children are less likely to receive medical care and more likely to have poor health status. In 2013, more than 4.8 million children under age 18 did not have health insurance. This represents 6.6 percent of all children in the United States. More than half of children (53.2 percent) were covered by private insurance, and 37.7 percent were covered by public insurance (e.g., Medicaid or other state-sponsored health plans including Children’s Health Insurance Program [CHIP]). Children’s health insurance status varies by several factors, including race, ethnicity, and income.

Important Facts

  • Households with incomes below 100 percent of poverty had the highest percentage of children with public health insurance (82.3 percent) and the lowest percentage of children with private health insurance (8.4 percent).

  • The highest percent of children who were uninsured were children living in households with incomes of 100–199 percent of poverty (11.1 percent), children from households with incomes below 100 percent of poverty (8.2 percent).

  • Children in households with incomes of 200 percent or more of poverty were more likely to have private coverage (81.7 percent). Resource: The full report, Child Health USA 2014 March 2015 U.S. Department of Health and Human Services Health Resources and Services Administration can be accessed at

Resource:
Access the full report​Child Health USA 2014 March 2015, U.S. Department of Health and Human Services Health Resources and Services Administration.


in 2013, more than uninsured, representing 8.9 percent of all children in the United States.
In 2013, more than uninsured, representing 8.9 percent of all children in the United States.

This map depicts the percentage of pediatric patients with health insurance coverage by state.
The map above depicts the percentage of pediatric patients with health insurance coverage by state.

Definiti​ons

The ASEC asks respondents about their health insurance coverage throughout the previous calendar year. Respondents may report having more than one type of coverage. In this analysis, individuals are sorted into only one category of insurance coverage using the following hierarchy:

Medicaid: Includes those covered by Medicaid, the Children's Health Insurance Program (CHIP), and those who have both Medicaid and another type of coverage, such as dual eligible who are also covered by Medicare.

Employer: Includes those covered by employer-sponsored coverage either through their own job or as a dependent in the same household.

Other Public: Includes those covered under the military or Veterans Administration as well as nonelderly Medicare enrollees.

Non-Group: Includes individuals and families that purchased or are covered as a dependent by non-group insurance.

Uninsured: Includes those without health insurance and those who have coverage under the Indian Health Service only.

For example, a person having Medicaid coverage in the first half of the year but employer-based coverage in the last months of the year would be categorized as having Medicaid coverage in this analysis.

N/A: Estimates with relative standard errors greater than 30% are not provided.

​Sou​​rces

Kaiser Family Foundation estimates based on the Census Bureau's March 2015 Current Population Survey (CPS: Annual Social and Economic Supplements).​


A majority of children (96.2 percent) had a usual source of care, such as a physician's office or health center, in 2012. The percentage of children with a usual source of care was highest among privately insured children (98.2 percent) and lowest among those who were uninsured (73.2 percent).

For additional re​sources view:​

Children's Health Spending
The report covers the health care cost and utilization trends for Americans younger than age 65 and covered by employer-sponsored insurance (ESI) for the years 2010 through 2014, and it is the first look at the 2014 data. In 2014, the insurance exchanges opened with varying participation and enrollment by state. Although impacts of the Affordable Care Act may have occurred in 2014 on the ESI trends discussed in this report, none of those were explicitly investigated here. The impact of the ACA on the health care trends of the ESI population is an important topic for future study.​

Comparison of Health Care Spending and Utilization Among Children With Medicaid Insurance
Most pediatric health care costs are concentrated in a small group of children with high resource use. There is limited research about how types of health services experienced by these children compare with children who have lower resource use.​

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