Access and quality in child health services: voltage drops
Abstract
Children require a health care system that promotes healthy development for all children while reaching out to the neediest. Barriers to care have been described as "voltage drops"-resistance points at which patients drop from the system like voltage from an electrical current. We examine the size and nature of these drops, ranging from insurance access to service quality, with respect to children. We find critical policy needs (such as expanded insurance opportunities, increased care coordination, and improved quality measurement) at all system levels. Comprehensive access to insurance and services does not guarantee that children will receive high-quality (safe and effective) care.
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Receiving developmental support services is the last in a series of steps from screening to referral to evaluation to delivery, and each step is vulnerable to leakage ("voltage drops"), with disparities compounding throughout.
“Receiving these services is the last in a series of steps from screening to referral to evaluation to delivery. Each step is vulnerable to leakage (“voltage drops”), with disparities compounding throughout.10–12”
From Sustained Effectiveness of a 211 Call Center With Early Childhood Care Coordination (2025) · cites this paper as [12]
Cites
Institute of Medicine (2000) · National Academies Press eBooks · doi:10.17226/9728 · Cited by 14,174 · see citing works
Medication Errors and Adverse Drug Events in Pediatric Inpatients
Kaushal, R. (2001) · JAMA · doi:10.1001/jama.285.16.2114 · Cited by 1,917 · see citing works
Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents.
Green, M. (1994) · Cited by 1,662 · see citing works
Unmet Need for Mental Health Care Among U.S. Children: Variation by Ethnicity and Insurance Status
Kataoka, S. H., Zhang, L., & Wells, K. B. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.9.1548 · Cited by 1,566 · see citing works
Trends in Antimicrobial Prescribing Rates for Children and Adolescents
McCaig, L. F. (2002) · JAMA · doi:10.1001/jama.287.23.3096 · Cited by 518 · see citing works
Health Insurance Coverage in the United States
(2002) · Duke University Press eBooks · doi:10.1215/9780822383536-003 · Cited by 501 · see citing works
Left Out: Immigrants’ Access To Health Care And Insurance
Ku, L. C., & Matani, S. (2001) · Health Affairs · doi:10.1377/hlthaff.20.1.247 · Cited by 492 · see citing works
The Unmet Health Needs of America's Children
Newacheck, P. W., Hughes, D., Hung, Y., Wong, S. T., & Stoddard, J. J. (2000) · PEDIATRICS · doi:10.1542/peds.105.s3.989 · Cited by 457 · see citing works
Computerized Physician Order Entry and Medication Errors in a Pediatric Critical Care Unit
Potts, A. L., Barr, F. E., Gregory, D. F., Wright, L., & Patel, N. R. (2004) · Pediatrics · doi:10.1542/peds.113.1.59 · Cited by 410 · see citing works
Christakis, D., Mell, L. K., Koepsell, T. D., Zimmerman, F. J., & Connell, F. A. (2001) · PEDIATRICS · doi:10.1542/peds.107.3.524 · Cited by 409 · see citing works
Access to Health Care for Children With Special Health Care Needs
Newacheck, P. W., McManus, M. A., Fox, H. B., Hung, Y., & Halfon, N. (2000) · PEDIATRICS · doi:10.1542/peds.105.4.760 · Cited by 406 · see citing works
Racial/ethnic differences in children's access to care
Weinick, R. M., & Krauss, N. A. (2000) · American Journal of Public Health · doi:10.2105/ajph.90.11.1771 · Cited by 336 · see citing works
Design and operation of the National Survey of Children with Special Health Care Needs, 2001.
Bramlett, M. D., Blumberg, S. J., Ormson, A. E., George, J. M., Williams, K. L., Frasier, A. M., Skalland, B. J., Santos, K. B., Vsetecka, D. M., Morrison, H. M., et al. (2003) · PubMed · Cited by 305 · see citing works
Strickland, B. B., McPherson, M. G., Weissman, G., van Dyck, P., Huang, Z. J., & Newacheck, P. W. (2004) · PEDIATRICS · doi:10.1542/peds.113.s4.1485 · Cited by 293 · see citing works
King, W. J., Paice, N., Rangrej, J., Forestell, G. J., & Swartz, R. (2003) · Pediatrics · doi:10.1542/peds.112.3.506 · Cited by 281 · see citing works
Adams, R., Fuhlbrigge, A. L., Guilbert, T. W., Lozano, P., & Martínez, F. D. (2002) · Journal of Allergy and Clinical Immunology · doi:10.1067/mai.2002.125489 · Cited by 256 · see citing works
Recommendations for Preventive Pediatric Health Care
(2000) · PEDIATRICS · doi:10.1542/peds.105.3.645 · Cited by 229 · see citing works
Flores, G., Lee, M., Bauchner, H., & Kastner, B. (2000) · PEDIATRICS · doi:10.1542/peds.105.3.496 · Cited by 223 · see citing works
Anticipatory Guidance: What Information Do Parents Receive? What Information Do They Want?
Schuster, M. A., Duan, N., Regalado, M., & Klein, D. J. (2000) · Archives of Pediatrics & Adolescent Medicine · doi:10.1001/archpedi.154.12.1191 · Cited by 193 · see citing works
Self-citationFewtrell, M. S., Morley, R., Abbott, R. A., et al. (2002) · PEDIATRICS · doi:10.1542/peds.110.1.73 · Cited by 186 · see citing works
Prevention of Drowning in Infants, Children, and Adolescents
Brenner, R. A. (2003) · PEDIATRICS · doi:10.1542/peds.112.2.440 · Cited by 185 · see citing works
Mallory, M. D., Shay, D. K., Garrett, J. M., et al. (2003) · PEDIATRICS · doi:10.1542/peds.111.1.e45 · Cited by 179 · see citing works
Eisenberg, J. M., & Power, E. J. (2000) · JAMA · doi:10.1001/jama.284.16.2100 · Cited by 158 · see citing works
Factors That Influence Receipt of Recommended Preventive Pediatric Health and Dental Care
Yu, S. M., Bellamy, H. A., Kogan, M. D., et al. (2002) · PEDIATRICS · doi:10.1542/peds.110.6.e73 · Cited by 156 · see citing works
Pediatric Patient Safety in Hospitals: A National Picture in 2000
Miller, M. R., & Zhan, C. (2004) · PEDIATRICS · doi:10.1542/peds.113.6.1741 · Cited by 149 · see citing works
Expanding Public Health Insurance to Parents: Effects on Children's Coverage under Medicaid
Dubay, L. C., & Kenney, G. S. (2003) · Health Services Research · doi:10.1111/1475-6773.00177 · Cited by 145 · see citing works
Assessing Health System Provision of Well-Child Care: The Promoting Healthy Development Survey
Bethell, C. D., Peck, C., & Schor, E. L. (2001) · PEDIATRICS · doi:10.1542/peds.107.5.1084 · Cited by 138 · see citing works
National Hospital Ambulatory Medical Care Survey: 1992 emergency department summary.
McCaig, L. F. (1994) · PubMed · Cited by 127 · see citing works
Effectiveness of Compliance With Pediatric Preventive Care Guidelines Among Medicaid Beneficiaries
Hakim, R. B., & Bye, B. V. (2001) · PEDIATRICS · doi:10.1542/peds.108.1.90 · Cited by 126 · see citing works
Are Market Forces Strong Enough To Deliver Efficient Health Care Systems? Confidence Is Waning
Nichols, L. M., Ginsburg, P. Β., Berenson, R. A., et al. (2004) · Health Affairs · doi:10.1377/hlthaff.23.2.8 · Cited by 95 · see citing works
Bethell, C. D., Klein, J., & Peck, C. (2001) · Medical Care · doi:10.1097/00005650-200105000-00008 · Cited by 89 · see citing works
Mainous, A. G., Hueston, W. J., Davis, M. P., et al. (2003) · American Journal of Public Health · doi:10.2105/ajph.93.11.1910 · Cited by 87 · see citing works
Children’s Health Insurance Status and Emergency Department Utilization in the United States
Luo, X., Liu, G., Frush, K. S., & Hey, L. A. (2003) · PEDIATRICS · doi:10.1542/peds.112.2.314 · Cited by 81 · see citing works
Guevara, J. P., Mandell, D. S., Rostain, A. L., Zhao, H., & Hadley, T. R. (2003) · PEDIATRICS · doi:10.1542/peds.112.6.e440 · Cited by 79 · see citing works
The Effects of HMO Penetration on Preventable Hospitalizations
Zhan, C., Miller, M. R., Wong, H., et al. (2004) · Health Services Research · doi:10.1111/j.1475-6773.2004.00231.x · Cited by 71 · see citing works
Who Should Determine When Health Care is Medically Necessary?
Rosenbaum, S. E., Frankford, D. M., Moore, B. B., et al. (1999) · New England Journal of Medicine · doi:10.1056/nejm199901213400312 · Cited by 69 · see citing works
Why Aren't More Uninsured Children Enrolled in Medicaid or SCHIP?
Haley, J. (2001) · Cited by 58 · see citing works
Hakim, R. B., & Ronsaville, D. S. (2002) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/archpedi.156.10.1015 · Cited by 48 · see citing works
Has Medicaid Managed Care Affected Beneficiary Access and Use?
Zuckerman, S., Brennan, N. J., & Yemane, A. (2002) · INQUIRY The Journal of Health Care Organization Provision and Financing · doi:10.5034/inquiryjrnl_39.3.221 · Cited by 47 · see citing works
Provision of Sexual Health Services to Adolescent Enrollees in Medicaid Managed Care
Lafferty, W. E., Downey, L., Holan, C. M., et al. (2002) · American Journal of Public Health · doi:10.2105/ajph.92.11.1779 · Cited by 27 · see citing works
Continuity of Medical Care, Health Insurance, and Nonmedical Advice in the First 3 Years of Life
Bradford, W. D., Kaste, L. M., & Nietert, P. J. (2003) · Medical Care · doi:10.1097/01.mlr.0000102368.39193.5a · Cited by 16 · see citing works
Squeezing SCHIP: States Use Flexibility to Respond to the Ongoing Budget Crisis
Hill, I. T. (2004) · Cited by 16 · see citing works
Low-Income Children and Health Insurance: Old News and New Realities
Rosenbaum, S., & Budetti, P. P. (2003) · PEDIATRICS · doi:10.1542/peds.112.se1.e551 · Cited by 5 · see citing works
Perrin, J. M. (2004) · Ambulatory Pediatrics · doi:10.1367/1539-4409(2004)4 · Cited by 4 · see citing works
State Efforts to Insure the Uninsured: An Unfinished Story
Long, S. H., & Marquis, M. (2003) · RAND Corporation eBooks · doi:10.7249/rb4558.1 · Cited by 2 · see citing works
Perrin, J. M. (2002) · Ambulatory Pediatrics · doi:10.1367/1539-4409(2002)002
Wiecha, J. (2001) · doi:10.1367/1539-4409(2001)001
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Sustained Effectiveness of a 211 Call Center With Early Childhood Care Coordination
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Self-citation
- Authors
- Chung, P. J., & Schuster, M. A.
- Affiliations
- University of California, Los Angeles (US)
- Venue
- Health Affairs
- Publisher
- Health Affairs Publishing, LLC
- Published
- 2004-09
- Volume
- 23
- Issue
- 5
- Pages
- 77-87
- ISSN
- 0278-2715 (ISSN-L)
- 1544-5208
- OpenAlex
- W2166483323
- Cited by
- 35
- References
- 47
- Citations by year
- 2025: 1 · 2022: 1 · 2019: 4 · 2017: 1 · 2016: 1 · 2014: 3 · 2012: 1
- FWCI
- 7.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Affairs (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- child health services, health care access, quality of care, barriers to care, health insurance coverage, care coordination, quality measurement, pediatric care, health policy
- MeSH terms
- Child, Child Health Services, Child, Preschool, Delivery of Health Care, Health Services Accessibility, Humans, Poverty, Quality of Health Care, United States
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