|
|
| Home | Current Issue | Archives | Topic Collections | Search | Blog | Subscribe | Contact Us | Help |
|
Health Affairs, 23, no. 5 (2004):
112
doi: 10.1377/hlthaff.23.5.112 © 2004 by Project HOPE |
|
 |
|||||||||||||
Investing In Children |
PROLOGUE
Investing In Children’s Health And Health Care
PROLOGUE: The health needs of children differ so widely from those of adults or the elderly that most comparisons are not very meaningful. But in some ways, changes over time in relative resource allocations for these age groups may signal dangers that Americans can ill afford to ignore. Economic and demographic changes have raised the overall average wealth of the elderly in recent decades, while poverty has risen among children by many measures. Public budgets and informal private cross-subsidies for health care have been under severe pressure from rising costs, posing particular risks for dependent populations at both extremes of the age distribution. Some policy measures have alleviated the trend toward diminished relative spending on the young. The Balanced Budget Act (BBA) of 1997 cut Medicare and created the State Children’s Health Insurance Program (SCHIP). But BBA givebacks and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, combined with pressure on Medicaid from state revenue shortfalls, have refueled the adverse trend for children.
One closely watched index of intergenerational equilibrium is research spending, and the intricacies of the balance are apparent in the following examination by Daniel Gitterman and colleagues of changes in the National Institutes of Health’s "pediatric portfolio" during the period 1998–2003, when the NIH budget doubled. After a period of robust growth, though, NIH spending on pediatric research has dropped off and now trails biomedical inflation. As Gitterman and colleagues suggest, and as Lisa Simpson discusses in a companion essay, a further frontier is the need to widen the application of best practices established in clinical research. Gitterman and colleagues also note astutely that invidious inter-generational comparisons can be defused by emphasizing a life-cycle focus in pediatric research that highlights the lifelong health gains and savings produced by timely investments in the right kind of prevention and care for children.
Looking more broadly at the intergenerational balance, Susmita Pati and colleagues update earlier studies that traced relative resource allocations for overall social spending on young and old, including funds for education, welfare, and Social Security as well as health. Pati and colleagues find that overall spending grew faster for the elderly than the young from 1980 to 2000. But Paul Newacheck, author of an earlier analysis of generational equity from 1965 to 1986, and Ted Benjamin add a commentary on Pati’s paper; they conclude that the sharp trend toward divergence in the earlier period moderated during the latter span. Newacheck and Benjamin observe further, however, that federal funds for the elderly tend to be more stable than state-based health and education programs for children, who are thus more vulnerable to economic downturns.
| Home | | | Current Issue | | | Archives | | | Topic Collections | | | Search | | | Blog | | | Subscribe | | | Contact Us | | | Help |
|
© 2001-2004 Project
HOPE–The People-to-People Organization |
||||||||||||||||