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Abstract
The Los Angeles Healthy Kids program was created in 2003 to provide health insurance to uninsured children ages 0–5 years in families with household income below 300 percent of the federal poverty level (FPL) who are ineligible for SCHIP or Medicaid. A quality of care survey sampled parents of 538 children ages 12–72 months enrolled in the program for at least one year. Results show that quality of preventive care for children in Healthy Kids has similar patterns as care for children in low-income households, both in California and nationally. Content of preventive care is well below American Academy of Pediatrics (AAP) recommendations, although it is consistent with statewide and national levels of care.
Introduction
The Los Angeles Healthy Kids program was created in 2003 to provide health insurance to uninsured children ages 0–5 years. A year later, the program was expanded to cover older children, ages 6 through 18, as well. The program covers children in families with household income below 300 percent of the federal poverty level (FPL) who are ineligible for Healthy Families and Medi-Cal. First 5 LA funded Healthy Kids to improve health and well-being for young children. While insurance coverage should improve access to medical care for acute illnesses as well as chronic care, First 5 LA hoped to improve access to and the quality of preventive care as well. Because primary care for children ages 0–5 years provides important opportunities for preventive health care as well as early identification of problems with health, learning, and development, there is value in understanding the extent to which health care priorities of prevention and health promotion for young children are being met.
Background
In addition to medical check-ups and immunization, preventive care for young children focuses on identifying developmental concerns and providing parents with information on an array of topics, including anticipatory guidance about what behaviors to expect in young children and parental education to emphasize the importance of positive, development-promoting activities, such as reading to their child regularly. Developmental monitoring, which includes routinely asking parents during well-child visits about any concerns they have regarding the child’s growth, learning, and development, helps clinicians to prioritize guidance and counseling to meet the parents’ needs. Discussing parental concerns is also important for identifying issues within the family or about the child as early as possible.
The Healthy Kids parent survey provides the first information in Los Angeles County on the quality of health care for young children, including developmental monitoring and screening and the content of anticipatory guidance. This survey creates an opportunity to compare the experience of Healthy Kids enrollees with other subgroups of young children using recent state and national surveys.
(End of excerpt. The entire paper is available in PDF format.)
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