Myers Carlie N, Rao Meera, Bandi Rishiraj, Densley Sebastian, Diaz Daniella, Knecht Michelle, Sacca Lea
Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine Cincinnati, Cincinnati, OH, United States.
Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States.
Front Public Health. 2025 Jul 24;13:1611720. doi: 10.3389/fpubh.2025.1611720. eCollection 2025.
Pediatric health disparities remain widespread among marginalized populations, driven by structural racism, poverty, and unequal access to care. While the Centers for Medicare and Medicaid Services (CMS) and the Children's Health Insurance Program (CHIP) have advanced equity in pediatric healthcare, ongoing threats to federal funding jeopardize this progress. This commentary examines five articles, including four CMS-funded interventions that address pediatric health inequities by targeting key social determinants of health (SDoH), including access to care, neighborhood conditions, and insurance coverage. Interventions reviewed include Functional Family Therapy (FFT) for adjudicated youth, a hospital-led asthma management initiative in Ohio, community-based care engagement strategies in disorganized Chicago neighborhoods, and a national policy analysis of CHIP's effectiveness. Across these studies, common themes emerged: community engagement, cross-sector collaboration, and expanded insurance access improved outcomes and reduced costs. Medicaid expansion reduced in-hospital mortality and improved access to rehabilitative care, while CHIP increased preventive service use among near-poor children. However, persistent barriers-including racial and geographic inequities-continue to limit care engagement. While pediatric healthcare research has moved beyond disparity detection, implementation of targeted, evidence-based interventions remains limited. Without sustained investment in CMS and CHIP, the infrastructure supporting equitable pediatric care may erode, exacerbating health gaps for the most vulnerable. Policymakers must prioritize funding and support for initiatives that integrate medical, social, and structural solutions to pediatric health disparities. Strengthening CMS-supported programs is essential not only for improving child health outcomes but also for reducing long-term healthcare costs and advancing pediatric health equity.
儿科健康差异在边缘化人群中仍然普遍存在，其原因是结构性种族主义、贫困以及获得医疗服务的机会不平等。虽然医疗保险和医疗补助服务中心（CMS）以及儿童健康保险计划（CHIP）在促进儿科医疗保健公平方面取得了进展，但联邦资金面临的持续威胁危及这一进展。本评论审视了五篇文章，其中包括四项由CMS资助的干预措施，这些措施通过针对关键的健康社会决定因素（SDoH）来解决儿科健康不平等问题，这些因素包括获得医疗服务的机会、社区环境和保险覆盖范围。所审查的干预措施包括针对被判定有罪青少年的功能家庭疗法（FFT）、俄亥俄州一项由医院主导的哮喘管理倡议、芝加哥混乱社区基于社区的护理参与策略以及对CHIP有效性的全国政策分析。在这些研究中，出现了一些共同主题：社区参与、跨部门合作以及扩大保险覆盖范围改善了结果并降低了成本。医疗补助扩大计划降低了住院死亡率并改善了康复护理的可及性，而CHIP增加了接近贫困儿童的预防性服务使用。然而，持续存在的障碍——包括种族和地理不平等——继续限制护理参与。虽然儿科医疗保健研究已经超越了差异检测，但有针对性的循证干预措施的实施仍然有限。如果不对CMS和CHIP进行持续投资，支持公平儿科护理的基础设施可能会受到侵蚀，加剧最弱势群体的健康差距。政策制定者必须优先为整合医疗、社会和结构性解决方案以解决儿科健康差异的倡议提供资金和支持。加强CMS支持的项目不仅对于改善儿童健康结果至关重要，而且对于降低长期医疗成本和推进儿科健康公平也至关重要。
