Financing Health Care for the Medically Indigent Child

Abstract

Children should not be denied access to the health care system because of financial barriers or preexisting medical conditions, and yet evidence suggests that for millions of children this is the case. The American Academy of Pediatrics (AAP) in its 1986 "Medicaid Policy Statement" and its 1983 "Principles of Child Health Financing" espoused the belief that all children have a right to receive comprehensive and quality health care. Regrettably, no national policy exists which addresses medical indigency among children and their families. Although most state legislatures have considered the indigent care issue, they have focused primarily on hospitals1 uncompensated care burdens and not on ambulatory care needs. Moreover, because of budget implications and the lack of federal revenues, these state initiatives appear to be limited measures and are not intended to support comprehensive, long-range health care plans for the medically indigent. Data show that lack of ambulatory care, is a significant problem for medically indigent children. Comparisons of average numbers of visits to physicians for uninsured and insured children point to measurable service gaps.1 In particular, medically indigent children are not receiving the primary preventive care promulgated by the AAP and its "Recommendations for Preventive Pediatric Health Care." The AAP believes that equitable financing solutions for the medically indigent child must be developed immediately. The purpose of this statement is to inform AAP Fellows and health policymakers of the growing numbers of underserved children and to recommend remedial action by the federal, state, and local governments, as well as the private sector.