Health Affairs, 23, no. 5 (2004): 76 doi: 10.1377/hlthaff.23.5.76 © 2004 by Project HOPE	New Online   Pay Cuts For Medicare Docs   Access To Care Woes   Public Coverage More Efficient   Empowering Consumers

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Quality & Access

PROLOGUE

Children’s Health Care: Quality And Access Issues

Prospects for a future turnaround on the child front are obscured by U.S. demographic trends, which only seem to exacerbate the barriers to gains in child population health indictors. One such obstacle is the age-old issue of a dearth in public investment. Observers point out the potentially debilitating impact that the "graying" of the U.S. population may have on the country’s ability to devote sufficient resources to the health care of its youth. Susmita Pati and colleagues note in this issue, for example, that the 2004 Medicare Trustees’ Report predicts Medicare spending growth from 2.6 percent of gross domestic product (GDP) in 2003 to 7.75 percent in 2035, even though the social indicators of seniors are already strong relative to those of children. These spending priorities have also raised eyebrows in light of the fact that the absolute population of impoverished American children has grown to be three times higher than the number of impoverished elders during the past twenty years.

Children’s advocates argue that child health care has become an unwitting casualty of an intergenerational conflict that pits the most vulnerable segments of our population, the young and the old, against each other in the competition for increasingly scarce social welfare dollars. The papers that follow address this and other obstacles and chart a course forward for improving children’s health indicators. First, Paul Chung and Mark Schuster expose as a fallacy the notion that recent efforts aimed at improving overall health care quality automatically translate into gains for children’s health. They identify various points at which the health care system "loses" children and propose mitigating interventions. Next, Jeanette Rogowski, Douglas Staiger, and Jeffrey Horbar discuss strategies for reducing infant mortality through improving the quality of neonatal intensive care. Finally, Robert Giffin, Kathleen Stratton, and Rosemary Chalk offer a tutorial on the U.S. vaccine/immunization infrastructure and attempt to navigate emerging challenges that threaten to undermine it.

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