Division of Advanced General Pediatrics and Primary Care (JD Kusma), Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Ill; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center (JD Kusma), Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Ill.
Department of Pediatrics (A Arauz Boudreau and JM Perrin), Harvard Medical School, Boston, Mass; Division of General Academic Pediatrics (A Arauz Boudreau and JM Perrin), MassGeneral Hospital for Children, Harvard Medical School, Boston.
Acad Pediatr. 2024 Sep-Oct;24(7S):S178-S183. doi: 10.1016/j.acap.2023.08.005.
Health financing for children and youth comes mainly from commercial sources (especially, a parent's employer-sponsored insurance) and public sources (especially, Medicaid and Children's Health Insurance Plan [CHIP]). These 2 sources serve populations that differ in race and ethnicity. This inherent segregation perpetuates a system of disparities in health and health care. Medicaid (and CHIP) have become the largest single provider of health insurance to US children and youth, currently insuring over 50% of all children and youth, with even higher rates for children of racial and ethnic minorities. Medicaid provides substantial benefit to the populations it insures, with good evidence of both short- and long-term improved health and developmental outcomes, and better health and well-being as adults. Nonetheless, some characteristics of Medicaid, especially the major state-by-state variation in eligibility, enrollment practices, and covered services, along with persistent low payment rates, have helped to maintain a separate and unequal health program for racial and ethnic minority children and youth. Several changes in Medicaid-including linking CHIP more closely with Medicaid, strengthening national standards of payment and care, assuring coverage of all children, and incorporating social and family risk adjustment-could make the program even more beneficial and diminish racial differences in child health financing.
儿童和青少年的健康融资主要来自商业来源（特别是父母雇主赞助的保险）和公共来源（特别是医疗补助和儿童健康保险计划 [CHIP]）。这两个来源服务的人群在种族和民族上存在差异。这种固有的隔离现象使卫生保健方面的差距永久存在。医疗补助（和 CHIP）已成为美国儿童和青少年最大的单一医疗保险提供者，目前为所有儿童和青少年提供超过 50%的保险，少数民族儿童的保险率更高。医疗补助为其承保的人群提供了大量的福利，有充分的证据表明短期和长期的健康和发展结果都得到了改善，成年后的健康和福祉也更好。尽管如此，医疗补助的一些特点，特别是资格、参保和承保服务方面在各州之间的重大差异，以及持续的低支付率，都有助于为少数族裔儿童和青少年维持一个单独和不平等的健康计划。医疗补助的几项改革——包括将 CHIP 与医疗补助更紧密地联系起来、加强支付和护理的国家标准、确保所有儿童的参保、以及纳入社会和家庭风险调整——可以使该计划更加有益，并减少儿童健康融资方面的种族差异。
