Children's health worthy of investment


State performance scorecard tracks uninsured kids, access, quality and costs. Often lack of data stalls quality incentives in pediatrics

In 2008, the Commonwealth Fund provided additional food for thought with its publication of a state-by-state scorecard of the quality of children's care, "U.S. Variations in Child Health System Performance: A State Scorecard," which focused on 13 performance indicators of access, quality, costs, equity and the potential to lead healthy lives. Among its findings, the study reported that the proportion of uninsured children ranged from 5% in Michigan to 20% in Texas, and that 75% of Massachusetts children receive regular medical and dental care versus 46% in Idaho. More than half of children in the New England states have a medical home, compared with just one-third in Mississippi.

Edward Schor, MD, vice president of the Commonwealth Fund and one of the study's authors, says the report highlights the need to extend health insurance to as many children as possible.

Dr. Schor adds that the study is intended to help states improve children's healthcare.

"The scorecard is not designed to beat up on any particular state, but to show that some states can pull this off," he says. "So when a state asks why it's low, I say 'call one of the higher ranking states. They'll tell you how they did it.'"


While the Commonwealth Fund study has interested insurance providers, translating its findings into meaningful changes in coverage and pricing-or contracting with healthcare providers-remains a challenge. That's because compared with adult care, the industry has little data regarding quality measures and outcomes for children.

McAndrews believes pediatric hospitals could play an important role in plugging the children's healthcare data gap and finding ways to improve quality. He proposes using hospitals as hubs linking pediatric subspecialties in their communities.

"The specialists would get to know one another and develop mechanisms for collecting information, then, by linking with other children's hospitals across the country, sharing data, and working with managed care organizations, we could make a real difference in improving the quality of care for children."

For Dave Schinderle, vice president of finance for hospital operations at Children's Hospital of Orange County in Orange, Calif., the regional variance in children's healthcare comes as little surprise. He believes the same dynamics that drive people who treat adults apply to people who treat children.

Schinderle says there has been talk among the major insurers with whom the hospital contracts about instituting incentives to reward quality and cost-cutting, but little action thus far.

"What I'm hearing is there's just not enough data for the payers to feel like they've got solid ground to stand on when it comes to pediatric medicine," he says.

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