How our health care system is failing children

December 14th, 2017

This fall, Congress let funding for the Children’s Health Insurance Program (CHIP) expire for the first time since creation of the program in 1997. The program covers about 9 million children and 320,000 pregnant women throughout the country, mostly in the low-to-moderate income level. Several states are nearing the limit of their available CHIP funding and some are close to shutting down the program, which is terrifying for the millions of families that rely on CHIP for their child’s health care.

But even if CHIP funding is reinstated before the end of the year (which some political reporters assume it will be), we still have a long way to go to ensure that all children have a chance for a healthy life. Threatening children’s health coverage is just one of the many ways our health system has failed American children, as evidenced by recent health news.   

Few incentives to prevent chronic conditions

Asthma is the most common childhood medical condition, with 8.4% of children in the US suffering from asthma. Rates of asthma are especially high for children of color; in 2009, 17% of African American children and 11% of Latino/a children had asthma.

Earlier this month, The Washington Post explored how asthma is being treated in Baltimore, MD, a city that encompasses several asthma “hot spots.” They found that despite Maryland’s innovative system of global budgeting, which rewards investments in preventive care, major hospitals in Baltimore profit handsomely from treating acutely ill asthma patients instead of preventing asthma attacks.

Johns Hopkins medical center and a sister hospital received $31 million from 2013-2015 treating asthma attacks alone. The most affected patients, who came to the hospital with asthma attacks at least ten times in three years, accounted for $6.1 million in reimbursements to Baltimore hospitals. The Post notes that asthma triggers can be easily mitigated with pest removal and moisture control, but no hospital has yet invested substantially in removing these triggers through home remediation.

Hospitals aren’t accountable to communities

Baltimore is just one example of how large hospitals are neglecting to prevent chronic conditions in their communities that impact children. In a Politico investigation earlier this year, the author pointed out that the Cleveland Clinic is thriving financially (and continues to receive tax breaks for its non-profit status), while the neighborhood the Clinic resides in has an infant mortality rate three times as high as the national average, few healthy food options, and a dangerous lead exposure problem. 

In a recent STAT op-ed, Duke University cardiology fellow Haider Warraich proposes that hospitals should earn their non-profit status, by forming true partnerships with communities and devoting more of their resources to community health initiatives. In order to do that, we need a clearer definition of what constitutes a sufficient community benefit and increase oversight for how hospitals allocate this benefit, Warraich writes. The hard part of that will be convincing hospitals to give up their assumed tax-exempt status.  

Inadequate investment in treating social conditions

It’s not only hospitals that fail to prioritize community care. While our country spends 17% of its GDP on health care, it only spends 9% on social services, the lowest rate out of 11 high-income nations. This has had a devastating effect on children’s health, writes former Modern Healthcare editor Merrill Goozner. Since CHIP was implemented, certain markers of children’s health have improved, such as vaccination rates, access to dental care, and teen alcohol use, writes Goozner. 

But the social conditions that ultimately determine childhood well-being are moving in the opposite direction. The new threats are existential, mental and physical. They are the outgrowth of poverty, violence, and deprivation. About 1 in 5 children are growing up in poverty and another 20% live in households between 100% and 200% of the federal poverty level. The share of youths age 12 to 17 reporting a major episode of depression rose to 13% in 2015 from 9% in 2004. Child obesity shows no signs of abating, and obesity-related health consequences like high blood pressure, diabetes, early puberty and asthma are climbing. 

Even if Congress reauthorizes CHIP, they cannot pat themselves on the back for protecting children’s health, as long as they keep ignoring the social and economic factors that damage health from the start.