Minnesota Title V MCH Needs Assessment Fact Sheets

Children and Adolescents

Access to Health Care

August 2004

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Size of the Problem

Minnesota 2000 census data report for children ages 1 to 17 years: 1,218,894. There are an additional 284,191 older adolescents/young adults between the ages of 18 to 21.

Approximately 68,000 children in Minnesota are uninsured [1].

Eighteen to 24 year olds have the highest uninsured rates of any age group at a rate of 21 percent [2].

In 2004, there are about 3,000 active practicing dentists in MN and only about 30 are in the specialty practice of pediatric dentistry [3].

Approximately 21,775 children under 18 years old received some type of mental health service through public dollars (county and state) in Minnesota in 1999. It is estimated that these services reached approximately 30% of the total number of children with emotional disturbance in Minnesota [4].

Seriousness

Access issues such as lack of insurance, discontinuous insurance coverage, lack of providers, and the structure of delivery systems become barriers to receiving health care services.

A recent Minnesota survey of parents showed that while the majority of children in Minnesota had health insurance coverage (95.5%) and dental coverage (79%) in 2002, however there are significant variations by race and income.

  • Black children in Minnesota are about 2.5 times more likely to be uninsured than children overall, and Hispanic children are nearly four times more likely to be uninsured [5].
  • In Minnesota children with family incomes below 200% of poverty have uninsurance rates that are about three times higher than the rate for all children [6].
  • Younger children were more likely to have health insurance coverage than older children [7].
  • Nationally, when compared with other children, Hispanic/Latino children were most likely to have unmet needs and least likely to have a usual place of health care [8].

For each child without medical insurance, there are almost three children without dental insurance [9].

More than eight in 10 uninsured Americans come from working families. Nearly 70% of the uninsured are in families with one or more full-time workers [10].

Uninsured children are at risk for health problems. Uninsured children are less likely to receive proper medical care for childhood illnesses.

Almost 17% of Minnesota parent’s reported that appointment scheduling made it difficult to get their child in for a well-child visit in 2002 [11]. However, greater accessibility of primary care is associated with better health outcomes [12].

Children and adolescents in non-metro counties face additional barriers to mental health treatment as most of these counties have a shortage of mental health professionals; specifically child psychiatrists [13].

In Minnesota, there are 4.6 child psychiatrists for every 100,000 children, compared to 6.73 for every 100,00 children in the United States as a whole [14].

It is difficult to accurately measure how many children and adolescents receive treatment for mental health problems because of the fragmented mental health care system [15].

Adolescents and young adults are most likely to be without a usual source of care and have lower ambulatory visit rates. Foregone care is common among teens, especially among those who are older, low-income, uninsured, from minority backgrounds, or involved in high risk behaviors [16].

Too few adolescents have access to appropriately designed and delivered health screening, preventive counseling and medical treatment. Other challenges include:

  • Lack of health care providers who understand adolescent health and enjoy working with teens;
  • Lack of easy access to services at convenient times and places that are “youth-friendly;”
  • Lack of confidentiality for sensitive health services; and
  • Difficulties in health care service financing when youth seek services outside of the traditional health service system.

In general, adolescents use health care services the least of any age group and are the least likely to seek care through traditional office-based settings [17].

Nationally, the annual costs of preventable adolescent health problems were estimated in 2002 to be $51.5 billion or $1,152 per adolescent [18].

Interventions

Health Care Coverage
Advocate for adequate health insurance coverage in either public or private programs for all children and adolescents. Conduct public awareness and outreach programs to promote the importance and value of coverage.

Work with partners and communities to assure that services and systems of care reach targeted populations.
Methods for improvement include working with partners to increase beneficiary outreach and education through training, technical assistance, and the development of resources. Strategies include creating helpful and easy to understand materials, and working with programs to reach special populations such as children with disabilities and working with existing programs such as WIC [19].

  • Utilize peer educators to encourage adolescents to use health care services and become active participants in health care decision-making, with particular attention directed to adolescents with low utilization patterns, especially males, Hispanics, immigrants, and youth not in school [20].

Develop and promote health services and systems of care designed to eliminate disparities and barriers across the MCH population.
Strategies to decrease disparities providers such as through non-traditional providers in school-based clinics [21], through a diverse workforce [22], as well as the through the promotion of a medical home [23].

  • The American Academy of Pediatrics supports a medical home that promotes access and coordinates care for children. Having a usual source of health care facilitates access to health care and is associated higher rates of preventive care use as well as higher ratings of the patient-physician relationship and fewer unmet needs [24].
  • Studies show that access to school based primary health care is associated with increased use of services, decreased use of emergency rooms, and decreased hospitalization.

Access to dental treatment cannot by itself eliminate the burden of dental caries. There must be multiple approaches that address family and community determinants of oral health. Healthy personal behaviors promote oral health, e.g. brushing the teeth with fluoride toothpaste at least once a day, eating healthy foods, helping parents learn about oral health and acquiring skills to prevent oral disease. Community programs such as water fluoridation and school-based dental sealant programs are very effective in reducing dental caries. All the determinants of oral health disparities – access to professional dental care and social, community, personal and familial factors must be adequately balanced to promote, improve, and maintain sound oral health [25].

Status

The importance of assuring access to quality health care is reflected in numerous public health goals, including the Healthy Minnesotans 2004 [26] and Healthy People 2010 [27].

The Cover All Kids initiative sponsored by Health Plans, the Children’s Defense Fund and the State of Minnesota promotes health care coverage and preventive care for Minnesota children and develops comprehensive, long-range plans to further improve preventive care and reduce health disparities for underserved children.

Minneapolis and St Paul Public Schools have a number of school based health clinics serving primarily high school aged youth.

The Minnesota Department of Health, the Minnesota Board of Dentistry, and the Minnesota Department of Human Services have implemented programs and strategies that promote oral health for children and adolescents.

  • Establishment of a Dental Health Access Advisory Committee.
  • Promotion of Child and Teen Check-up, Early and Periodic Screening, Diagnostic and Treatment and Head Start programs.
  • Increased dental provider reimbursement rates for diagnostic examinations, dental radiographs, fluorides and sealants for children.

References

1. Compiled by the State Health Access Data Assistance Center, University of Minnesota School of Public Health, using US Census data, June 2004.
2. Minnesota Department of Health. (April 2002). Minnesota’s uninsured: Findings from the 2001 Health Access Survey.
3. Minnesota Department of Health. (2004). 2002 BRFSS child health module data book.
4. (Minnesota Department Human Services, Children’s Mental Health Division, 2000). (Action plan)
5. Minnesota Department of Health. (April 2002). Minnesota’s uninsured: Findings from the 2001 Health Access Survey.
6. Minnesota Department of Health. (April 2002). Minnesota’s uninsured: Findings from the 2001 Health Access Survey.
7. Minnesota Department of Health. (April 2002). Minnesota’s uninsured: Findings from the 2001 Health Access Survey.
8. Blackwell D.L., Tonthat L. (2002) Summary of Health Statistics for US Children: National Health Interview Survey, 1998. National Center for Health Statistics. Vital Health Stat 10(208).
9. U.S. Department of Health and Human Services. (2001). Trends in children’s oral health.
10. Kaiser Commission on Medicaid and the uninsured. (2003). The uninsured: A primer, key facts about Americans without health insurance.
11. MDH. 2002 BRFSS Child Health Module Data Book. 2004.
12. Shi L, et al.(2002) Primary Care, Self-Rated Health and Reductions in Social Disparities in Health. Health Serv Res 37:529-50.
13. Children’s Defense Fund Minnesota. (2004). A special report from Minnesota KIDS COUNT, a project of Children’s Defense Fund Minnesota. Online resource: www.cdf-mn.org/PDF/KidsCountData_04/MentalHealthData.pdf [Attn: Non-MDH Link
14. Children’s Defense Fund Minnesota. (2004). A special report from Minnesota KIDS COUNT, a project of Children’s Defense Fund Minnesota. Online resource: www.cdf-mn.org/PDF/KidsCountData_04/MentalHealthData.pdf [Attn: Non-MDH Link]
15. Children’s Defense Fund Minnesota. (2004). A special report from Minnesota KIDS COUNT, a project of Children’s Defense Fund Minnesota. Online resource: www.cdf-mn.org/PDF/KidsCountData_04/MentalHealthData.pdf [Attn: Non-MDH Link]
16. Ford, CA, Bearman, PS, & Moody, J. (1991). Foregone health care among adolescents. JAMA, 282(23): 2227-2234.
17. Klein, JD, Slap, GB, Elster, AB, Cohn, SE. (1993) Adolescents and access to health care. Bulletin of the New York Academy of Medicine, winter: 219-235.
18. Gans, JE, Alexander, B, Chu, RC, Elster, AB. (1995). The cost of comprehensive preventive medical services for adolescents. Archives of Pediatrics and Adolescent Medicine, 149(11):1226-1234. Converted to 2002 dollars using the US department of Labor’s Bureau of Labor Statistics’ Medical Care Consumer Price Index.
19. US General Accounting Office (2001). Medicaid- Stronger Efforts Needed to Ensure Children’s Access to Health Screening Services. GAO –01-749.
20. McManus, MA, Shejavali, KI & Fox, HB. (2003). Is the health care system working for adolescents? Maternal & Child Health Policy Research Center.
21. English A., (1993) Early Periodic Screening, Diagnosis and Treatment Program (EPSDT): A Model for Improving Adolescent’s Access to Health Care. Journal of Adolescent Health, 14.
22. McDonough, J., Gibbs, B., Scott-Harris. J., Kronebusch, K., Navarrd, A., Taylor, K., (2004). A State Polich Agenda to Eliminate Racial and Ethic Health Disparities. The Commonwealth Fund; New York, NY.
23. National Center for Health Statistics. (1996). Current estimates from the National Health Interview Survey.
24. Inkelas M., Schuster, M., Olson, L., Park C., Halfon, N., (2004). Continuity of Primary Care Clinician in Early Childhood. Pediatrics, 113; 6
25. Partnership in Prevention. (2001). Oral health: Common and preventable ailments. Priorities in Prevention.
26. MDH Healthy Minnesotans Public Health Improvement Goals 2004. Accessed 8-4-04. /divs/chs/phg/intro.html
27. Healthy People 2010. Accessed 8-4-04.
www.healthypeople.gov/Document/HTML/Volume1/01Access.htm#_Toc489432807 [Attn: Non-MDH Link]