Policy & Advocacy

Children’s Healthcare Policy Discussion
Memo to the New Administration of President Obama

On December 31, 2008, The National Initiative for Children’s Healthcare Quality, a nonprofit organization whose vision is that all children will receive the health care they need, convened a discussion group to inform the incoming administration about the health care challenges facing our country—particularly those facing the children of our nation—and about broad policy approaches the Obama administration should implement to address them. The discussion group included 15 participants from across the nation—Colorado, Ohio, New York, Delaware, and Massachusetts. All the participants were health care professionals from different disciplines—nurses, physicians, policy analysts—working in the delivery and management of children’s health care services.

Preamble:  Children are our future, yet the health and well being of America’s children fare poorly compared to those of all other developed nations.  Even within the US, child health, access and quality vary across race, economics, and geography. Because children’s health needs, as well as the organization and financing of their health care, differ from those of adults, health care reform need pay special attention to these differences if we are to succeed as a nation.

We group our recommendations into three broad areas: Prevention, Organization and Finance, and System Performance and Improvement.  All of these recommendations rest on the fundamental assumption of universal health insurance for children through age 18 years, a floor on which other system reforms can be built.

1. Prevention and Population Health

• Emphasis on community health measures to support healthy choices: creation of incentives for communities to develop policies that support a healthy environment for children, including smoke free environments, healthy food choices, safe play, public transportation.
• A redefined, developmentally appropriate health benefits  package that encompasses the whole child, including services that both prevent and address needs stemming from environmental and social factors and address women’s health needs as the strongest determinant of child health.

2. Organization and Finance

On the assumption that the US continues with a state administered health insurance system for poor children (Medicaid and SCHIP) vs. a universal federal program modeled on Medicare (“MediKids”), our priorities are:
Development, demonstration and use of incentive systems and technical supports that promote the integrated delivery of care in a medical home for all children and the coordination of services.

• The creation of a commission with strong consumer participation focused on children and youth to advise Congress on strategies to achieve high-performing SCHIP and Medicaid programs, modeled on the Medicare Payment Advisory Commission that advises Congress on issues affecting the Medicare program.
• Assuring that comparative effectiveness research includes issues relevant to children’s health and that upstream funding is targeted to address areas with limited information.

3. Improvement and System Performance

• Development, endorsement and use of incentives to promote a standard set of performance measures addressing the continuum of children’s health needs.
• Investment in programs and standards that assure health information technology will specifically address the needs of children, including those children with special health care needs.
• Creation of national and regional resources to provide technical assistance for quality improvement in children’s health care given that the current quality improvement infrastructure only addresses the care of Medicare recipients.