The Children's Health Policy Conference

Frederick A. Connell

First, the good news: Many indicators of child health in Washington are improving. The bad news, according to the 1995 report on The State of Washington's Children, is that this progress is tenuous and could be reversed by current and pending changes in the health care system. The report also states that social and community problems are increasingly serious threats to children's health. Inadequacies in family income, adult supervision, and community resources contribute significantly to the "new morbidity" of child abuse, teen pregnancy, teen suicide, and youth violence. These threats are heightened by possible health care funding cuts in Medicaid and the health care system changes brought on by managed care.

Potential major disruptions in provision of health care for children in the state prompted convening of the First Annual Washington Children's Conference in Seattle on September 22-23, 1995. The State of Washington's Children which was released at this conference, provided the starting point for discussion. Proposed state and federal legislation, particularly regarding Medicaid and child welfare, and rapid changes in the health care system made clear the need to inform health care professionals and educate legislators and other decision makers about the potential effects of these developments on the health and well-being of children in Washington.

John Neff, medical director of Children's Hospital Medical Center, conceived the idea for the conference, which was sponsored by university, public, and private groups (sidebar). The conference drew 250 attendees and featured presentations by health care providers, advocates, and policy analysts, and by policymakers from the Washington State Department of Social and Health Services and Department of Health. State Senator John Moyer (R-Spokane) and representatives for Governor Mike Lowry and Senators Slade Gorton and Patty Murray also addressed the conference.

Painful Choices Ahead?

At both state and federal levels, health policy discussions have focused largely on reducing expenditures for Medicaid, the federal-state health program for the poor. Over the past decade this program has grown significantly Jane Beyer, assistant secretary of the Department of Social and Health Services who supervises our state's Medicaid program, estimated that 470,000 children, approximately one-third of those in this state, will have their health care paid for by Medicaid by 1997, More than 40% of deliveries are now covered by Medicaid, and the proportion of children with major medical problems and disabilities who are covered by Medicaid is higher.

In the past Washington has been a leader in expanding Medicaid eligibility and in ensuring an appropriate,

accessible, and adequate mix of services for those in need. Proposed strategies to reduce the federal share of Medicaid spending may have a significant deleterious effect on this program. If Congress imposes restrictions on its rate of growth that make it impossible to keep up with the growth in population, inflation, and the costs of new technologies. Medicaid policymakers will need to make painful choices.

Who should bear the brunt of these reductions: children, pregnant women, the disabled, or the elderly?
Should Medicaid provider payments be reduced, jeopardizing the willingness of medical providers to serve Medicaid patients?
Should restrictions be made in the kinds and amounts of services that have been reimbursed by Medicaid?
Should certain eligibility groups be dropped from the program, with a consequent increase in the number of uninsured persons in the state?

Effect of Managed Care

Much of the conference was devoted to discussions of the potential effect of managed care on children. Robert Lehman, of the Adolescent Clinic at the University of Washington Medical Center, discussed the concerns of experts who feel that managed care plans may present barriers to adolescents who want to seek confidential health care. Furthermore, access to health care for traditionally disenfranchised adolescents, such as homeless and runaway youth, may decline in a system that requires enrollment into a managed care plan.

This same problem was stressed by Donald Gargas, a pediatrician at the Yakima Valley Farmworker's Clinic, where as many as 70% of his clients have no health insurance. Without clinics devoted to special populations migrants, teens, inner city families - access to care may be nonexistent, with or without managed care. John Neff summarized the concerns of experts regarding how well managed care will serve the needs of children with complex medical problems and severe disabilities. Although these children are a minority of the total childhood population, Dr. Neff estimated that approximately 10% of children have a moderate-to-severe chronic medical problem, and 2% have truly severe conditions requiring specialized and sophisticated care.

Managed care for vulnerable children will be a challenge for health care providers, policymakers, children, and families in the years ahead. The next conference is scheduled for September 24, 1996. For information or a copy of the proceedings of the 1995 conference, contact Children's Hospital and Medical Center Continuing Medical Education, (206) 526-2501.

Major Findings Info Recommended Reading
The State of Washington's Children, 1995 Report. Seattle: University of Washington School of Public Health and Community Medicine. Copies are available from Washington Kids Count, (206) 685-7613.
Author
Frederick A. Connell, M,D., M.PH., is professor of health services, adjunct professor of pediatrics and epidemiology, and director of the Maternal and Child Health Program at the University of Washington.

Return to the Table of Contents

Return to Northwest Public Health

Last update: 02/13/97