Health care for children and youth in the United States: 2002 report on trends in access, utilization, quality, and expenditures

Ambul Pediatr. Mar-Apr 2004;4(2):131-53. doi: 10.1367/1539-4409(2004)4<131:HCFCAY>2.0.CO;2.


Objective: To examine changes in insurance coverage, health care utilization, perceived quality of care, and expenditures for children and youth in the United States using data from 1987-2001.

Methods: Three national health care databases serve as the sources of data for this report. The Medical Expenditure Panel Survey (1996-2001) provides data on insurance coverage, utilization, expenditures, and perceived quality of care. The National Medical Expenditure Survey (1987) provides additional data on utilization and expenditures. The Nationwide Inpatient Sample (1995-2000) from the Healthcare Cost and Utilization Project provides information on hospitalizations.

Results: The percent of children uninsured for an entire year declined from 10.4% in 1996 to 7.7% in 1999. Most changes in children's health care occurred between 1987 and the late 1990s. Overall utilization of hospital-based services has declined significantly since 1987, especially for inpatient hospitalization. Several of the observed changes from 1987 varied significantly by type of health insurance coverage, poverty status, and geographic region. Quality of care data indicate some improvement between 2000 and 2001, which varies by insurance coverage. Overall, mean length of stay of hospitalizations did not change significantly from 1995 to 2000, but changes in the prevalence of hospitalizations and the length of stay associated with age-specific diagnoses were evident during this time period.

Conclusions: Health care for children and youth has changed significantly since 1987, with most of the changes occurring between 1987 and 1996. Insurance coverage has improved, the site of care has shifted toward ambulatory sites, hospital utilization has declined, and expenditures on children as a proportion of total expenditures have decreased. Variation in these changes is evident by insurance status, poverty, and region.

MeSH terms

  • Adolescent
  • Adolescent Health Services / economics*
  • Adolescent Health Services / standards*
  • Aid to Families with Dependent Children / statistics & numerical data
  • Ambulatory Care / economics
  • Ambulatory Care / statistics & numerical data
  • Child
  • Child Health Services / economics*
  • Child Health Services / standards*
  • Child, Preschool
  • Databases, Factual
  • Health Care Surveys
  • Health Expenditures / statistics & numerical data
  • Health Expenditures / trends*
  • Health Services Accessibility / trends*
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data
  • Humans
  • Infant
  • Insurance Coverage / classification
  • Insurance Coverage / statistics & numerical data
  • Insurance Coverage / trends*
  • Insurance, Health / statistics & numerical data
  • Medical Assistance / statistics & numerical data
  • Medically Uninsured / statistics & numerical data
  • Public Health Informatics
  • Quality of Health Care / trends*
  • United States