Why is health care access important during the first 36 months of life? The American Academy of Pediatrics and the Centers for Disease Control state that children need to be immunized against 15 different diseases during this period. Additionally, 9 of these vaccines are administered in multiple doses during this time period (CDC, 2009). Pediatricians are also an important source of early detection for developmental delays including cognitive, social/emotional and physical delays. Early Intervention Services can effectively remediate many types of developmental delays and have a demonstrated cost benefit of $13 in public savings for every $1 invested (Glascoe & Shapiro, 2007).
There is also a demonstrated connection between having insurance and consistent health care access. Uninsured children do receive health care services, but often they do not receive all of the care that they need when it is needed. This can be very expensive for them and the healthcare system since paying for chronic pre-existing conditions is significantly more expensive than providing preventive care (Stoll and Thorpe, 2005).
So who currently pays for care for uninsured children? A 2005 Families USA report revealed that roughly 1/3rd is paid by uninsured children’s families, 1/3rd is paid for through a combination of existing government programs and the final third is passed on to privately insured individuals and families in the form of higher health insurance premiums. The report estimated that the average privately insured family in Tennessee will be paying just over $1,299 extra in health insurance premiums each year by 2010 to cover the cost of providing health care for uninsured individuals (Stoll and Thorpe, 2005).
Increasingly, children whose families earn too much to qualify for publicly funded health insurance programs (Medicaid and SCHIP) lack insurance. California responded to this reality by creating the Children’s Health Initiative (CHI). The first Children’s Health Initiative was created in 2001 in Santa Clara County. Currently there are Children’s Health Initiatives in 30 counties and during their 8 years of existence, they have helped provide health insurance to 88,000 uninsured children (California Children’s Health Initiatives, 2009).
Children’s Health Initiatives work by enrolling eligible children in Medi-Cal, California’s Medicaid program, and Healthy Families, their SCHIP program. Children who are ineligible for either program are enrolled in locally funded and non-profit programs. The Initiative is primarily funded through the Foundation community of California, including the David and Lucille Packard Foundation, the California Endowment and the Tides Center. The programs which provide health insurance for children who do not qualify for Medi-Cal or Healthy Families include:
- Healthy Kids, a locally operated insurance program that does not have income eligibility limits. Families pay low premiums and co-pays for health, dental and vision coverage.
- CalKids, a non-profit program for children ages 2 through 18 whose families earn below 250% FPL, regardless of immigration status;
- Kaiser Permanente Child Health Plan, a state level program that provides low cost care for all children who do not qualify for state plans, regardless of family income.
There are also two federal and state funded programs that provide care for children with identified disabilities or medically necessary care.
To date, the CHI has demonstrated improved access to dental and medical care services, reduced child hospitalizations and improved health care status for many children statewide who would have lacked coverage otherwise (Cousineau et al, 2007; Howell and Trenholm, 2007; Phipps et al, 2008).
California Children’s Health Initiative (2009). History. Altadena, CA: The Tides Center. Accessed August 14, 2009. < http://www.cchi4kids.org/history.php>
California Children’s Health Initiative (2009). Vision and Mission. Altadena, CA: The Tides Center. Accessed August 14, 2009. < http://www.cchi4kids.org/vision&mission.php>
California Children’s Health Initiative (2009). Partners. Altadena, CA: The Tides Center. Accessed August 14, 2009. <>
Centers for Disease Control and Prevention (2009). Recommend Immunization Schedule for Persons Aged 0 through 6 Years. Washington D.C.: Author. Accessed August 14, 2009. <>
Cousineau, Michael R., Gregory D. Stevens and Trevor A. Pickering (December 2007). Children’s Health Initiatives Have Helped Prevent Over 1,000 Unnecessary Child Hospitalizations Annually. University of Southern California: Center for Community Health Studies. Accessed August 14, 2009. <>
Glascoe, F.P. & Shapiro, H.L.(2007). Introduction to developmental and behavioral screening.
Developmental Behavioral Pediatrics Online, www.dbpeds.org
Howell, Embry and Christopher Trenholm (March 2007). Santa Clara County Children’s Health Initiative Improves Children’s Health. Los Altos, CA: David and Lucille Packard Foundation. Accessed August 14, 2009. <>
Phipps, Kathy, Joel Diringer, T. Em Arpawong, Chris Feifer, Michael R. Cousineau, and Gregory D. Stevens (July 2008). Dental Utilization in California’s Children’s Health Initiatives’ Healthy Kids Programs. University of Southern California: Center for Community Health Studies. Accessed August 14, 2009. <>
Stoll, Kathleen and Kenneth Thorpe (June 2005). Paying a Premium: The Added Cost of Care for the Uninsured. Washington, D.C.: Families USA. Accessed August 14, 2009. <>