A new scorecard system that examines state child health performance across America, reveals wide disparities among states, according to a report released today, Wednesday 28th May.

The report from The Commonwealth Fund, concludes that millions more American children would be insured, have access to health care, and experience less delay in their development if all the states of the US did as well as the top performers: Iowa, Vermont, Maine, Massachusetts, and New Hampshire.

Using a new system that they called the state scorecard, the researchers behind the report ranked each state’s performance in child healthcare according to 13 indicators arranged in five areas of performance: access, quality, costs, equity, and potential to lead long healthy lives.

They ranked each state within each of the 13 indicators, and averaged the indicator ranks to work out the ranking for each of the five areas of performance. The average of all five performance areas (they called them dimensions) gives a state’s overall rank.

The report also compares each state to benchmarks already achieved in one or more states. The authors said there was a pressing need for better quality data on measures of children’s health at state level.

The results suggest that an American child’s potential to live a long, healthy and productive life depends on which state they grow up in. There are also wide disparities among states in the quality of care that their children receive, the amount of insurance premium their families pay, how easy it is for children to access health care and how equitably children are treated by their health systems.

In hard figures, the report estimates that if all states performed as well across the 13 indicators as the top states, then the impact on children throughout the US would be:

  • 4.6 million more would have health insurance.

  • 11.8 million more would get their recommended annual medical and dental check ups.

  • 1.6 million fewer would be at risk of delays in their development.

  • 10.9 million more would have a medical home.

  • Nearly 0.8 million more would be up to date with their vaccinations.

The authors said that while no single state was top in all categories, some were far better than the rest. On the whole, Northeast and upper Midwest were the best performers in several areas, while most of the lowest rankings across several categories were occupied by states in the South and Southwest USA.

But, the authors emphasized there was room for improvement even among the topmost states because they fell short of established standards on some of the indicators.

Report co-author and Commonwealth Fund Vice President, Dr Edward Schor, said:

“In looking at the country as a whole, we found that, while there are pockets of excellence, there is no one state or region that is doing as well as it could be.”

“This scorecard points to the need to make more information available about children’s health care and to improve the health care system for children,” he added, saying that the good news is “we know improvements can be made because we didn’t judge these states based on a pie in the sky standard; we judged them against one another.”

The figures showed that while the proportion of uninsured children varied widely, from 5 per cent in Michigan to 20 per cent in Texas, those whose children were nearly all insured (and therefore had the most access) were almost without exception among the best performers on quality and equity of care provision.

Those who scored badly overall also scored the worst on the access measure, the worst performing states here being Arizona, Florida, Louisiana, Mississippi, New Jersey, Nevada, and Texas.

As a general finding, the report shows that children in the bottom ranked states were less likely to get the recommended healthcare, including vaccines, dental care and regular check ups, and they also counted among those at greater risk of delays to their development and death in childhood.

The report recommends action in several key areas:

  • Adequate funding for state children’s health insurance to expand coverage for children.

  • National policies that allow families to afford health care and to be able to match benefits to children’s needs.

  • Standards for health care that ensure all children have access to high quality care.

  • More funding for research and data collection to allow more detailed and accurate picture of state by state performance on children’s health.

Commonwealth Fund President Karen Davis, who also co-authored the report said:

“The health of our children is paramount to our country’s long-term success.”

“This scorecard serves notice that children’s health and well-being are at risk,” she added, urging that:

“We must invest in children’s health and health care to ensure that they have the opportunity to become healthy and productive adults. The time to begin is now.”

The Commonwealth Fund is a New York based independent organization that describes itself as “working toward health policy reform and a high performance health system”.

” US Variations In Child Health System Performance: A State Scorecard.”
Katherine Shea, Karen Davis, and Edward Schor.
The Commonwealth Fund, May 2008.

Click here to read the Executive Summary and access the full report download.

Sources: The Commonwealth Fund.

Written by: Catharine Paddock, PhD