May 28, 2008 -- Iowa and Vermont provide children with the best health care, according to a report released today by an independent health care research foundation, while Oklahoma and Florida rank the worst when it comes to caring for kids.
The assessment, released by the Commonweath Fund, a private foundation focused on health care issues, ranked the 50 states and the District of Columbia to see how they fared on several counts, including health care access, quality, cost, equity and the potential for kids to lead long, healthy lives.
Researchers also took a close look at rates of insurance coverage, vaccinations and preventive visits to doctors, among other factors, concluding that there is a high correlation between a child's access to care and the quality of care that child receives.
"Iowa and Vermont have come out at the top of the scale on our measures," said Dr. Edward Schor, vice president of child development and preventive care at the Commonwealth Fund. "Both of these states have adopted policies to expand children's access to health care and improve their quality of care."
On the other hand, several bottom-ranked states had high numbers of uninsured children, and it was in those states that children were less likely to get recommended health care such as vaccines, dental care and regular checkups, according to the Commonwealth Fund president Karen Davis.
Researchers also concluded that there is enormous potential to make kids healthier. If faltering states performed as well as the strongest states did, the researchers said, an additional 4.6 million children across the country would have health insurance.
The changes would also result in as many as 800,000 more children being up to date on their vaccines and 11.8 million more children getting their recommended medical and dental checkups each year, according to the report.
"Investing in children is truly an investment in the future," Schor said. "It takes leadership at the state level as well as at the federal level."
Northeast and Heartland States Provide Best Kids' Health Care
Iowa did not rank first in any one health care category, but it still took the top spot for overall children's care.
According to Dr. Michael Artman, executive director and physician in chief at the University of Iowa's Children's Hospital, that's due in large measure to learning how to localize care for kids.
"Sometimes health care delivery in a rural state like Iowa is a little difficult," Artman said. "I think Iowa was very perceptive in recognizing that and working to develop systems so at least the screening systems and well-children care and identifying kids at risk -- all of that can be done in the local communities."
Several New England states followed top-ranking Iowa in providing children with the best overall care. Rounding out the top five were Vermont, Maine, Massachusetts and New Hampshire.
The regional cluster in the Northeast demonstrated that states where children were insured at high levels also came out on top in several other categories.
For instance, in Massachusetts, the state that ranked first for access to care, 75 percent of children had at least one medical and one dental visit in the past year compared with 46 percent of children who visited doctors and dentists in Idaho. Also in Massachusetts, 94 percent of young children were up to date on their immunizations, compared with 67 percent who were up to date in Nevada.
"A traditional measure of quality of health care is whether children get the key immunizations that are recommended for young children," Schor said.
Artman and researchers alike also touted the importance of a "medical home," also described as a primary care provider that families can go to as needed with their questions or concerns. Only one-third of children in Mississippi have a medical home, which contributed to the state's ranking as No. 49 overall. That's dramatically different from the 61 percent of children in New Hampshire who have a medical home they can access regularly.
"Health care and particularly child health care rests on the relationship between the family and the health care provider," Schor said.
Southern States Rank Low on List
Oklahoma ranked lowest on the Commonwealth Fund's list for children's health care. Florida, Mississippi, Louisiana and Arizona also took places at the bottom of the ranks.
Arizona, Louisiana, Mississippi also ranked close to the bottom when it came to access to care.
Across most states, minority, low-income and uninsured children received lower quality care. The rate of children who are uninsured ranged from 5 percent in Michigan to 20 percent in Texas.
Among Southern states, Alabama stood out as an exception to the trend, ranking 14th overall for kids' health care.
"Certainly with regard to Alabama, it was a matter of leadership," Davis said. "The state was the first one to take advantage of the state child health care program in 1997. It was also very efficient at forging a public-private partnership specifically with Blue Cross Blue Shield of Alabama."
To improve health care for children, the Commonwealth Fund recommended reauthorizing the State Children's Health Insurance Program, known as SCHIP, a federal program that aims to help states cover uninsured children in low-income families. Researchers attributed Iowa and Vermont's success in large part to that program and to the states' requirements for health plans and children's health care systems to report data on SCHIP.
Six million children nationwide are covered by SCHIP, and 28 million children nationwide are covered by Medicaid, meaning that more than one-third of children around the country get health care that's funded by the federal government as well as by the states.
President Bush and Democratic lawmakers in Congress butted heads over the details of reauthorizing SCHIP in 2007 and were forced to extend the program as is until next year.