A new report offers a road map for policy change and healthcare system transformation to better meet the needs of children and families.
The report from the National Academies of Sciences, Engineering, and Medicine documents increases in the incidence of chronic diseases; growing concerns with children’s mental, emotional, and behavioral health; and significant disparities among population groups. Rising rates of mortality and disability among youth and working age Americans illustrate the long-term outcomes of not providing the care that children need.
“Without systemic change, the next 10 years will see more young people entering adulthood with chronic illness, disability, and mental health issues,” said Tina Cheng, M.D., co-chair of the committee that wrote the report, in a statement. She is chair and professor of pediatrics at the University of Cincinnati, and chief medical officer and director of the Cincinnati Children’s Research Foundation at Cincinnati Children’s Hospital Medical Center. “This will have dramatic effects on quality of life for generations and will leave fewer adults capable of productive work in the years to come," she added.
The National Academies’ report centers on the healthcare sector, defined broadly to include clinical and community care, along with public health and school-based investments in child and family health. The committee looked at child health in a holistic way by including preconception, maternal, prenatal, child, adolescent, family, and community health and well-being.
According to the report, even with the nation’s expansion in insurance coverage, many children lack access to adequate preventive care. Most models of healthcare payment rely on fee-for-service structures or value-based arrangements that are designed to lower costs for adult patients, and do not provide child health clinicians with the flexibility or incentives to work with families and partner with communities to fully address their health and developmental needs, the report says.
The report recommends federal and state policymakers and the Centers for Medicare & Medicaid Services reform Medicaid and the Children’s Health Insurance Program (CHIP) to ensure continuous coverage and reduced state and territory variability in services for every child and parent under age 65 who lacks other insurance.
“We need to put kids first in how we think about healthcare, which will require a whole system transformation,” said committee co-chair James Perrin, M.D., professor of pediatrics at Harvard Medical School and former director of the Division of General Pediatrics at the MassGeneral Hospital for Children, in a statement. “National progress on improving long-term outcomes for all Americans will come only from a dedicated and ongoing commitment to improving the well-being of children, youth, and families.”
The report suggests that public and commercial payers should transition from predominant reliance on fee-for-service arrangements and explore payment incentives that emphasize prevention and health promotion services, team-based and cross-sector care, health equity, health outcomes, and longer return on investment.
State legislatures and Medicaid programs should also adopt and enforce policies that promote equitable payment for services delivered in school-based health centers and by other school providers.
Another recommendation is that the Centers for Medicare & Medicaid Services, in collaboration with other federal agencies, should support the implementation of new and updated accountability measurement systems, and federal research agencies should continue to advance data resources and collection to fill key knowledge gaps and provide a source of consistent measurement and insights.
