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PUBLIC HEALTH New Report Gives Data on Care for Children A new report by the Harvard Center for Children's Health and the U.S. Agency for Healthcare Research and Quality (AHRQ) provides the first comprehensive data on the health care of American children in more than a decade. The report, intended to be the first in an annual series, will serve as a baseline for tracking changes in health care delivery and access. The report appears in the Journal of the Ambulatory Pediatric Care Association, a special supplement to the January Pediatrics. The data will be useful for child health researchers, advocates, and policymakers, who have lacked reliable information in the past. Most previous information about health care has focused on the elderly, due to the larger pool of data available from Medicare. "There has been no nationally available data for children since 1987," says Marie McCormick, director of the Center for Children's Health at HSPH and lead author of the report. "That is part of the difficulty in trying to talk about what might be the options for child health financing policy in this country, because we really don't have that kind of information." Marie McCormick is lead author of a report giving researchers and policymakers data to track trends in children's health care. Categories of Care The report documents the kind of care that children receive based on categories like age, ethnicity, family employment status, and census region. It also looks at each category in terms of those children with private, public, or no insurance. Nearly 90 percent of children had either public or private insurance at some time during the year, though the report finds that "there is substantial movement of children on and off insurance." At any single point, the number of children who are uninsured rises to about 15 percent. McCormick says she was surprised by the percentage of adolescents hospitalized for complications related to childbearing and pregnancy—30 percent for those age 15 to 17, making it the most frequent cause of hospitalization for that group. Although the report held few other surprises for people who are familiar with the issues, some of the statistics show trends the public may be unaware of. McCormick notes, for instance, how children who have public or no insurance often have an employed parent, a fact she attributes to the increasing number of small businesses that do not offer insurance to their employees. Recent expansions in Medicaid have extended coverage to a greater number of children than many would expect: about 34 percent of infants less than 1 year old and 25 percent of children age 1 to 4 receive public health insurance. A relatively large number of adolescents age 15 to 17 are uninsured (about 12 percent) because they rely disproportionately on private insurance. The Study Sources The report relies on two data sets from AHRQ, the Medical Expenditure Panel Survey (MEPS) and the Healthcare Cost and Utilization Project (HCUP). MEPS is a survey that collects health care information from households based on interviews conducted in overlapping panels, allowing a relatively continuous set of information. Added to the household information are data from medical and health insurance providers. The HCUP is a cooperative federal, state, and private sector project to collect hospital discharge data for research. Future studies will have more timely data and will focus on details of certain health care issues, such as expenditures and state-by-state trends. The new data will help to create a better picture of children's heath care. With the reorganization of managed care organizations and the expansion of public insurance programs, the structure of health care is changing rapidly. "This is a particularly critical time to have even baseline data on what's happening to children and youth in this country, and then to monitor it over time," McCormick says. "There are some vulnerable subgroups that are small but very vulnerable, and these are the kids that you really want to track to make sure they're not getting as badly burned as we think they are." —Courtney Humphries