A Child-Sized Step in the Right Direction

Growing up with asthma — and having a keen interest in playing sports — not only gave my parents a few extra gray hairs, but also paints a picture that illustrates the Children’s Access to Care Index.

The index score is based on three components of access — Potential Access, Barriers to Care and Realized Access.  I had health insurance coverage and access to a pediatrician, similar to the 98 percent of children who have health insurance in Colorado.

I faced minimal obstacles to care, but visited the doctor more often than some, since a simple cough for someone with asthma can quickly turn into wheezing and troubled breathing. More trips to the doctor meant more time off from work for one of my two working parents, which can be a logistical barrier for some. And while I considered myself a brave child, having trouble breathing in the middle of the night often scared me and my parents. Late night trips to an urgent care clinic or emergency room were not unheard of when the pediatrician’s office was closed.

Children’s access to care is a complex topic, and every child’s story is different. That said, the Colorado Health Institute and the Colorado Coalition for the Medically Underserved have developed a way to measure various facets of access to care.  The first Colorado access to care index, based on 2013 data from a variety of sources, was released in March and updated in October with 2015 data. Now, we’ve supplemented the overall index with the first child-specific index that compares access indicators from 2015 with those based on 2013 information to assess changes over time.

Most children in Colorado are finding it easier to access health care. The index score increased to 8.4 in 2015 from 8.1 in 2013, both out of a possible 10 points.

But the beauty of the Children’s Access to Care Index is that we can dive deeper into the data and see what areas brought the score up and what areas remained unchanged.

The better overall score is mainly due to increases in potential access — the building blocks of access to care. This category includes indicators such as health and dental insurance coverage rates and workforce availability. Even though the Affordable Care Act did not focus on children’s coverage, many kids likely gained insurance as their parents enrolled in expanded Medicaid and tapped into other ACA provisions.

Still, obtaining care can be challenging, even for families and children with health insurance. The Barriers to Care section measures how difficult it is to access health care. A higher score suggests fewer barriers. The score for this category was 9.0 in 2015, unchanged from 2013. The data reveal an interesting trend — cost is cited less often as a barrier to care for children, but there is an uptick in the percentage of children not able to get an appointment when they need one.

Realized Access indicators measure if a child actually sees a provider. This category is largely comprised of preventive measures, which are good indicators of access to care. Hospitalizations are also included in this category because they may indicate inadequate access. The Realized Access score climbed a bit, to 7.2 in 2015 from 7.0 in 2013, although not quite as much as projected given the increase in health and dental insurance. 

Improving access to health care for children is certainly welcome. Get more insights into Children’s Access to Care here.