health care for children and youth in the united states: 2002 report on trends in access,...

AMBULATORY PEDIATRICS Volume 4, Number 2131Copyright q 2004 by Ambulatory Pediatric Association March–April 2004

Health Care for Children and Youth in the United States: 2002 Reporton Trends in Access, Utilization, Quality, and Expenditures

Lisa Simpson, MB, BCh, MPH; Marc W. Zodet, MS; Frances M. Chevarley, PhD;Pamela L. Owens, PhD; Denise Dougherty, PhD; Marie McCormick, MD,ScD

Objective.—To examine changes in insurance coverage, health care utilization, perceived quality of care, and expen-ditures 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 ExpenditurePanel 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 Nation-wide Inpatient Sample (1995–2000) from the Healthcare Cost and Utilization Project provides information on hospital-izations.

Results.—The percent of children uninsured for an entire year declined from 10.4% in 1996 to 7.7% in 1999. Mostchanges in children’s health care occurred between 1987 and the late 1990s. Overall utilization of hospital-based serviceshas declined significantly since 1987, especially for inpatient hospitalization. Several of the observed changes from 1987varied significantly by type of health insurance coverage, poverty status, and geographic region. Quality of care dataindicate some improvement between 2000 and 2001, which varies by insurance coverage. Overall, mean length of stayof hospitalizations did not change significantly from 1995 to 2000, but changes in the prevalence of hospitalizationsand 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 changesoccurring between 1987 and 1996. Insurance coverage has improved, the site of care has shifted toward ambulatorysites, 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.

KEY WORDS: health care utilization; hospitalization; insurance; quality; trends

Ambulatory Pediatrics 2004;4:131 153

Children and youth in the United States continue toexperience wide variation in the amount, quality,and costs of care they receive. While recent re-

ports have documented the steady decrease in the rate ofuninsurance among children and youth in the late 1990s,1

less is known about trends in the health care utilizationfor children. Numerous market-based strategies have beenimplemented in the last decade to shift care toward am-bulatory settings and away from hospital-based care, withsome documented success.2–4 In addition, advances inclinical practice, such as the introduction of the Hemophil-us influenzae B vaccine, have also supported a move to-ward ambulatory care. Finally, results are mixed in thegeneral population as to whether one factor, Health Main-tenance Organization (HMO) participation, is associatedwith a decrease in length of stay.5

From the Department of Pediatrics (Dr Simpson), University ofSouth Florida, St Petersburg, Fla; the Agency for Healthcare Re-search and Quality (Mr Zodet, Drs Chevarley, Owens, and Dough-erty), Rockville, Md; and the Department of Maternal and ChildHealth (Dr McCormick), Harvard School of Public Health, Boston,Mass.

Address correspondence to Lisa Simpson, MB, BCh, MPH, Pro-fessor of Pediatrics, ACH Guild Endowed Chair in Child HealthPolicy, University of South Florida, 601 4th St South, CRI 1008, StPetersburg, FL 33701 (e-mail: [email protected]).

Received for publication July 9, 2003; accepted September 27,2003.

As the country’s policy agenda focuses elsewhere, re-trenchments in the scope of public insurance programs forchildren are being discussed and implemented.6 However,numerous challenges remain in assuring access to high-quality care for children. Timely and in-depth informationis critical to ensuring that the policy debates at the Federaland state levels are based on the realities of health carefor children and adolescents in the United States. In ad-dition to providing the latest data available on health carefor children and youth, this report, the fourth in an annualseries, explicitly examines changes in key dimensions ofhealth care over time. The graphics and tables in thisprinted report are only a subset of the extensive data in-cluded in the electronic appendix pages of this journal.Given the important public policy changes since 1987,notably efforts to improve health insurance coverage oflow-income children through state insurance expansionsand the passage of the State Child Health Insurance Pro-gram (SCHIP), we have focused this report on results thatexamine patterns by health insurance, poverty level, andregion. Data illustrating changes from one point in timeto another for the other policy-relevant subgroups (eg,race/ethnicity, age, and health status) are included in theelectronic appendix material and not discussed in this re-port.

METHODSAs in previous years, the majority of the data for this

report are taken from two data sources maintained by the

AMBULATORY PEDIATRICS132 Simpson et al

Table 1. Summary of Data Sources, Time Periods, and Variables*

MeasureData

Source Time Period Components

Insurance MEPS 1987, 1996–99 (subpopulations) Full-year time reference: any private, public only, uninsured2001 (most recent data available) First half of year time reference: any private, public only, uninsured1996–99 (annual changes in insur-

ance coverage)Full-year time reference: private coverage entire year, public-only cov-

erage entire year, uninsured entire year

Utilization MEPSNMES

1996–991987

Office-based visits, hospital outpatient visits, hospital inpatient dis-charges, Emergency Department visits, dental visits, and prescriptionmedicines

HCUP 1995–00 Discharges, LOS, age groups, payer, hospital characteristics, diagnoses

Expenditures MEPS 1996–99 Office-based visits, hospital outpatient visits, hospital inpatient dis-charges, Emergency Department visits, dental visits, prescriptionmedicines, and source of payment

NMES 1987

Quality MEPS 2000–01 Second half of year time reference for CAHPS by first half of yeartime reference insurance coverage status (any private, public only,uninsured)

*MEPS indicates Medical Expenditure Panel Survey; NMES, National Medical Expenditure Survey; HCUP, Healthcare Cost and UtilizationProject; and LOS, length of stay.

Agency for Healthcare Research and Quality (AHRQ),Department of Health and Human Services (DHHS): theMedical Expenditure Panel Survey (MEPS) and theHealthcare Costs and Utilization Project (HCUP). Thesedata, their sampling strategies and components, and theanalytic methods used to produce the estimates have beenpreviously described in detail in earlier reports.7–9 In ad-dition, because significant changes in health care experi-ences are not typically detected over short time periods(ie, 1–4 years), data from the 1987 National Medical Ex-penditure Survey (NMES) were used to supplement theMEPS data and to establish a longer reference period (ie,9–12 years). This predecessor survey to the MEPS hasbeen documented in previous AHRQ and DHHS publi-cations.10,11 Insomuch as policy changes that affect publichealth insurance programs can have a more immediateimpact from one year to another (ie, expanding/restrictingpublic programs), we focus on insurance coverage from1996 to 2000; coverage estimates from 1987 are not in-cluded. Given the number of data sets used in this reportand the variation in the years available for each analysis,we have summarized these in Table 1.

Medical Expenditure Panel Survey

MEPS is an ongoing nationally representative family ofsurveys of medical care use and expenditures. MEPS pro-vides estimates of the health care utilization, expenditures,sources of payment, quality, and insurance coverage ofthe US civilian noninstitutionalized population from datacollected via multiple contacts over a 2½-year period. Thelatest data on utilization and expenditures presented in thisreport come from the 1999 MEPS Full Year ConsolidatedFile (HC-038), which includes data from the MEPSHousehold Component (MEPS-HC) and Medical ProviderComponent (MEPS-MPC) and are based on full-year re-sponses for children less than 18 years of age (n 5 6879).The most recent insurance coverage data presented in thisreport are based on part-year responses for children youn-

ger than 18 years (n 5 9973) and come from the 2001MEPS-HC Point-in-Time File (HC-034), which providesinformation on the nationally representative sample of thecivilian, noninstitutionalized population during the earlypart of 2001. Data on quality measures in this report arealso based on part-year responses for children youngerthan 18 years of age. They generally represent experiencesduring 2000 and 2001 and are based on responses to aParent Administered Questionnaire (PAQ) in 2000 (n 56577) and to the Child Supplement in 2001 (n 5 9000).Although the estimates we present are derived from pre-liminary files for both years, final data are available for2000 and will be available for 2001 in the respectiveMEPS-HC Full Year Population Characteristics files. Ad-ditional information on MEPS content and survey designare available, and the data can be obtained at http://www.meps.ahrq.gov.

For the purpose of looking at changes in utilization andexpenditures over time, data from the 1987 NMES arealso included in this report. Utilization and expenditureestimates were derived from the Household Survey com-ponent of NMES, which, like the MEPS-HC, is based ona national probability sample of the civilian noninstitu-tionalized population of the United States. Reported esti-mates are for the 1987 calendar year and are based onfull-year responses for children less than 18 years of age(n 5 9486).

Measures

Insurance. Estimates of insurance coverage are derivedfor two different reference periods. First, consistent withprevious efforts to report the most current data available,insurance coverage data are presented for approximatelythe first half of 2001; these data represent the most recentdata available during the production of this report. Sec-ond, for the purpose of observing changes in insurancecoverage over time (ie, 1996 to 2000) and for showinginsurance coverage in conjunction with the most recent

AMBULATORY PEDIATRICS Health Care for Children and Youth in the USA 133

utilization and expenditure data (1999), the full-yearMEPS-HC files were utilized.

Classification of insurance coverage status is defined intwo different ways for this article. First, as in previousreports, children are classified as having private insuranceif they were privately insured (including coverage throughthe Civilian Health and Medical Program of the Uni-formed Services (CHAMPUS/CHAMPVA/TRICARE) atany time during the reference period (ie, first half of theyear or entire year). Children with no private coverage butwho had any coverage through Medicaid, SCHIP (specif-ically probed beginning in 1999 MEPS), Medicare, or anyother type of government program providing coverage forboth hospital and medical care are classified as publiclyinsured. Children not covered by any comprehensive hos-pital and physician insurance program at any time duringthe reference period (ie, first half of the year or entireyear) are classified as uninsured. This classificationscheme is used when presenting the most recent insurancecoverage estimates (ie, 2001 Point-in-Time estimates) andwhen using insurance coverage as a population character-istic for subpopulation estimates of utilization, expendi-tures, and quality. Some children classified as having in-surance coverage (private or public) in 1999 or subsequentyears may have had utilization or expenditures during pe-riods in which they were uninsured or had a different typeof coverage. Second, for the purpose of examining insur-ance coverage over time (ie, 1999 to 2000), an alternativeclassification scheme is used to classify children as havingbeen insured through private coverage for the entire year,through public coverage for the entire year, or uninsuredfor the entire year. The estimated proportions of childrenwith mixed coverage (ie, some months uninsured and theother months with private/public coverage) for each re-spective year are not directly reported but are easily de-termined by subtracting the sum of the reported estimatesfrom 100.

Utilization. Utilization data include all office visits,hospital outpatient visits, inpatient hospital stays, emer-gency department (ED) visits, dental visits, and prescrip-tion medicines obtained for calendar years 1987 and 1996through 1999. In-person visits to both physician and non-physician providers are included. In MEPS, utilization andexpenditures for newborns are rolled into those categoriesfor the mother unless the newborn experienced a compli-cation resulting in an extended hospital stay (ie, beyondthe mother’s discharge). The NMES provides for two al-locations of inpatient birth events. The first considersstays for deliveries as two events: one for the mother andone for the infant. The second assigns the hospital utili-zation and expenditures for the infant to the mother unlessthe delivery was abnormal or unless the infant remainedin the hospital longer than the mother. Inpatient utilizationestimates were derived from NMES using the second al-location so as to be comparable to the MEPS data.

Expenditures. MEPS expenditures include all amountspaid for health care services from any source for all ser-vices provided for calendar years 1996 through 1999.Data for 1996 through 1999 were drawn from both the

household interviews in the MEPS-HC and from the sam-ple of health care providers included in the MEPS-MPC;data from the MEPS-MPC were used to edit household-reported data and impute for missing data. A more de-tailed description of the expenditure data, as well as theediting and imputation methodologies employed, is avail-able.12

Whereas MEPS uses actual payments as its expendituremeasure, the 1987 NMES uses charges as its expendituremeasure. Therefore, adjusted NMES expenditure mea-sures were used to improve the comparability to theMEPS. The adjustment method was based on an analysisof provider-reported payment data collected in NMES. In-formation on the development and implementation of thisadjustment method can be found in Zuvekas and Cohen.13

All further discussions involving expenditure estimatesfrom the NMES presented in this article refer to theseadjusted figures.

Inpatient hospital, outpatient department, and ED ex-penditures from NMES and MEPS include both hospitalfacility charges and doctors’ charges. Sources of paymentestimated from MEPS are grouped into private insurance(including payments made by any private health insuranceplan or CHAMPUS/CHAMPVA/TRICARE), Medicaid,out-of-pocket (including payments made by self or fami-ly), and other (includes Medicare and other insurance).Source of payment is not presented for 1987 becauseNMES categorizes the CHAMPUS/CHAMPVA sourceinto ‘‘Other Federal’’ sources, which also includes the In-dian Health Service and the Alaska Native Corporation,among others. It was not possible to reallocate theCHAMPUS/CHAMPVA payment dollars into the ‘‘Pri-vate’’ source category, as has become standard with theMEPS data in this series of reports. All expenditure esti-mates were adjusted to 1999 dollars using the ConsumerPrice Index.14

Quality of Care. Data on experiences with the medicalcare system were based on items added to the MEPS start-ing in 2000. These items were based on a subset of ques-tions from the health plan version of CAHPS, an AHRQ-sponsored family of survey instruments designed to mea-sure quality of care from the consumer’s perspective.15

Since 2000, parents have been asked in MEPS to reporton the following two dimensions of care: the extent ofproblems experienced in accessing care for their children(data in the top portion of Table A-10); as well as theirexperiences with the actual care provided (data in the bot-tom portion of Table A-10). Parents’ reports on the firstdimension were based on questions about the extent ofthe problem in receiving care for their children that theparent or doctor believed necessary, and the extent of theproblem in obtaining a referral to a specialist. Only par-ents of children who had doctor’s office or clinic visits inthe last 12 months were asked about care that the parentand/or doctor believed necessary; only parents of childrenwho the parents or a doctor thought needed to see a spe-cialist in the last 12 months were asked about obtaininga referral to a specialist. Parents’ reports on the seconddimension, experiences with the actual care, were based


on three items (data in the bottom of Table A-10) regard-ing the quality of care provided to their children duringthe past 12 months: how often providers listened carefullyto them, explained things clearly to them, and showedrespect for what they said. Only parents of children whomade one or more visits to a physician’s office or clinicin the last 12 months were asked to respond to these threeitems.

In 2000, these items were contained in the MEPS PAQ,and starting in 2001, they are contained in the ChildHealth and Preventive Care section of MEPS. There area number of differences in the administration of the PAQin 2000 and the Child Supplement in 2001. For instance,in 2000, parents were asked to complete a PAQ for eachof their children, whereas in 2001, an interviewer admin-istered the MEPS interview, including the Child Supple-ment, to a knowledgeable adult who was reporting forhimself and for other family members, including childrenyounger than 18 years of age. As a result, a larger per-centage of parents reported the information in 2000, whenthe questions were in the PAQ, than in 2001, when thequestions were in the MEPS core.

Consistent with efforts to report the most current dataavailable for examining variation in selected CAHPSmeasures by insurance coverage, insurance coverage dataare presented for approximately the first half of 2000 and2001, the most recent data available during the productionof the report (see Insurance section for more details).

Analysis

MEPS estimates of entire-year insurance coverage for1996 through 2000 were compared to evaluate changes inchildren’s health care coverage. In addition, estimates ofutilization and expenditures from the 1987 NMES, as wellas MEPS estimates from previous years’ reports (1996–98 data) and the most recent MEPS estimates (1999), werecompared to evaluate changes in these measures overtime. All MEPS and NMES estimates for all years andreference periods (first half of the year, full year) havebeen weighted to be nationally representative, and thestandard errors have been estimated, accounting for thecomplex design of the respective surveys, using the SU-DAAN software package (www.rti.org).16 In addition tothe survey point estimates, 95% confidence intervals forthe estimates are shown in the tables. These intervals re-flect the statistical precision of the corresponding estimate,with especially wide intervals indicating a large degree ofsampling error associated with the estimate. All differenc-es discussed in the text are statistically significant at the.05 level or better. No adjustments (eg, Bonferroni, Ben-jamini-Hochberg, etc) are made to compensate for thelarge number of comparisons presented in the report, be-cause the primary purpose of the report is to provide de-scriptive statistical estimates and to motivate further hy-potheses-driven research.

Formal tests for linear trends were not performed be-cause most observed differences in the measures occurredbetween 1987 and the late 1990s and were relatively sta-ble during the 4-year span in the 1990s. Also, there were

no data between 1987 and 1996 to examine the trend be-havior in our measures during this time.

Healthcare Cost and Utilization Project

In addition to data from MEPS, this study uses datafrom HCUP, an AHRQ-sponsored Federal-State-Industrypartnership established in 1988. HCUP databases bringtogether data collection efforts of state data organizations,hospital associations, private data organizations, and theFederal government to create a national information re-source of discharge-level administrative health care data(see ‘‘Acknowledgments’’). HCUP administrative dataprovide longitudinal estimates of all-payer state-, regional-, and national-level discharge information found in a typ-ical hospital discharge or billing record. Hospitals thatprovided discharge records were limited to those definedas community hospitals by the American Hospital Asso-ciation and included all non-Federal, short-term, general,and specialty hospitals, such as pediatric and oncologyhospitals, but excluded long-term care and psychiatrichospitals. In addition, prior to 1998, short-term rehabili-tation hospitals were included.

The 1995–2000 Nationwide Inpatient Sample (NIS)was used to examine trends in children’s hospitalizations.The discharge or hospital stay is the unit of analysis. Al-though the sampling and weighting strategy changed in1998,17 the NIS is designed to approximate a 20% strati-fied probability sample of US community hospitals, re-gardless of the year. The number of participating states inthe NIS grew from 19 states in 1995 to 28 states in 2000(The 28 states in the 2000 NIS were Arizona, California,Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois,Iowa, Kansas, Kentucky, Maine, Maryland, Massachu-setts, Missouri, New Jersey, North Carolina, New York,Oregon, Pennsylvania, South Carolina, Tennessee, Texas,Utah, Virginia, Washington, West Virginia, and Wiscon-sin.) In 2000, the NIS sampling frame comprised morethan 80% of all US hospital discharges. This NIS providesdischarge estimates from approximately 1000 hospitalsand 7 million hospital stays each year. When using hos-pital discharge weights to calculate national estimates thatare representative of all hospital inpatient stays in theUnited States, the total number of hospital stays in theUnited States is 36.4 million, of which approximately 6million are for children under the age of 18 years. Becauseof the large sample size, the NIS is uniquely suited tostudying detailed information about children’s hospitaliza-tions throughout the United States, including length ofstay (LOS) and reasons for hospitalization. Informationon HCUP databases is provided on the AHRQ Web site(www.ahrq.gov).

Measures

Trend data on hospitalizations focused on LOS, reasonfor admission, and expected payer. The LOS was calcu-lated by subtracting the admission date from the dischargedate. In addition, reason for admission, based on principaldiagnosis, was examined. Diagnoses were grouped ac-cording to the body system or major condition using the


Figure 1. Health insurance for children 17 years of age and youn-ger, 1996–00. A) Percent of children by all-year insurance status;B) Number of children by all-year insurance status. Source: 1996–2000 Medical Expenditure Panel Survey (MEPS). Agency forHealthcare Research and Quality.

Clinical Classification Software (CCS),18 a clinical grou-per that categorizes the International Classification of Dis-eases (ICD-9-CM) codes19 into a limited number of mu-tually exclusive categories. Expected payer was definedhierarchically. If the primary or secondary payer was aprivate (commercial) insurer, the payer was designated as‘‘private.’’ If neither payer was private, but Medicaid ap-peared on the record, the payer was designated as ‘‘Med-icaid.’’ All other types of insurance (eg, Medicare,CHAMPUS/TRICARE) were designated as ‘‘other.’’ Rec-ords with no third-party coverage of any kind were des-ignated as ‘‘uninsured.’’ Since hospital discharge abstractdata are generally compiled for billing purposes and theinternal code for SCHIP is dependent on the structure ofthe state program (ie, some programs are part of Medicaid,some programs are state-run non-Medicaid, and others aremanaged by private insurers), it was difficult to determinehow these discharges are categorized in the database (ie,Medicaid, other, or private insurance).

Analysis

Analyses for changes in inpatient stays between 1995and 2000 were conducted. Population ratios (number ofdischarges per number of children in the population) wereused to examine changes in the rate of hospitalizations byage, expected payer, and region. Age-specific, payer-spe-cific, and region-specific population estimates for 1995–2000 were obtained from the US Bureau of the Census(http://eire.census.gov/popest). In addition, analyses fo-cused on the mean LOS by age, expected payer, and re-gion; proportion of age-specific principal diagnoses; andmean LOS for selected age-specific principal diagnoses inchildren and youth.

All regional and national estimates were weighted byhospital-specific discharge weights to be nationally rep-resentative, and standard errors for all estimates were cal-culated using SUDAAN to account for the complex sam-pling design.16 In addition to point estimates, 95% confi-dence intervals are shown in the tables. All differencesdiscussed in the text are statistically significant at the .05level or better. Formal trend analyses were not completed,because sample sizes within age-specific conditions weretoo small to provide reliable linear trend test results, oncethe sampling frame of the NIS was taken into account.

Electronic Appendix Material

In order to provide a continuous time series of descrip-tive statistics, updated tables for the latest year availableare presented in the electronic appendices. MEPS datapresenting the details of changes over time and the mostrecent year available are shown in Appendix A. HCUPdata presenting trends and the most recent year availableare shown in Appendix B.

RESULTS

Use and Expenditures for Health Care Services

Insurance Coverage

The percent of children uninsured for an entire yeardeclined from 10.4% in 1996 to 7.7% in 1999 (Figure

1A). This translates into 7.0 million and 5.3 million un-insured children in 1996 and 1999, respectively (Figure1B). Most of the decline in full-year uninsurance was at-tributable to an observed 2.4 percentage point increase inthe proportion of children covered by private insurancefor an entire year, with the remainder of the differenceattributable to an increase in the percent of children withmixed coverage for the year (eg, some months uninsuredand the other months with private/public coverage) (datanot shown). The observed increase in private coveragewas not statistically significant. The percentages of chil-dren with private coverage and with public-only coveragefor an entire year remained relatively stable from 1996 to1999.

Health Care Use

Significant changes in utilization were observed be-tween 1987 and 1999 for a subset of health care services(Table 2). In addition, differing patterns emerged for somesubpopulations. While additional subpopulation data areprovided in the appendix tables (Appendix Tables A-1through A-6), details are provided here focusing on ratesby type of insurance, poverty level, and geographic re-gion. Overall, the proportion of children with at least oneoffice-based health care visit in a given year remainedunchanged from 1987 to 1999 (about 70%). However, sta-tistically significant changes were observed for a few sub-populations (Table A-1). For example, the proportion ofuninsured children with at least one office-based visit wassignificantly smaller in 1999 (43.0%) compared to both1987 (52.3%) and 1997 (54.7%) (Figure 2). Note, the


Tab

le2.

Hea

lthC

are

Use

for

Chi

ldre

n17

Yea

rsof

Age

and

You

nger

byY

ear

and

Typ

eof

Serv

ice*

Yea

r

Offi

ce-B

ased

Perc

ent

With

Any

Vis

its95

%C

I

Hos

pita

lO

utpa

tient

Perc

ent

With

Any

Vis

its95

%C

I

Hos

pita

lIn

patie

nt

Perc

ent

With

Any

Dis

char

ges

95%

CI

Em

erge

ncy

Dep

artm

ent

Perc

ent

With

Any

Vis

its95

%C

I

Den

tal

Perc

ent

With

Any

Vis

its95

%C

I

Pres

crip

tion

Med

icin

e

Perc

ent

With

Any

Scri

pts

95%

CI

1987

1996

1997

1998

1999

70.2

71.5

69.9

68.9

70.1

(68.

7,71

.7)

(70.

0,73

.1)

(68.

5,71

.4)

(67.

3,70

.5)

(68.

3,71

.9)

11.8 7.3

6.8

6.5

6.1

(10.

5,13

.0)

(6.3

,8.

2)(6

.0,

7.5)

(5.6

,7.

3)(5

.4,

6.9)

4.7

2.9

2.7

2.9

2.6

(4.1

,5.

3)(2

.4,

3.5)

(2.3

,3.

2)(2

.5,

3.4)

(2.1

,3.

1)

17.1

12.9

11.9

11.8

11.1

(16.

0,18

.2)

(11.

9,14

.0)

(11.

1,12

.8)

(10.

9,12

.8)

(10.

3,12

.0)

40.1

42.5

41.3

42.1

42.1

(38.

3,41

.9)

(40.

5,44

.5)

(39.

5,43

.2)

(40.

1,44

.1)

(40.

2,44

.1)

50.9

55.6

52.5

50.5

50.3

(49.

3,52

.5)

(54.

1,57

.1)

(51.

1,54

.0)

(48.

9,52

.1)

(48.

5,52

.0)

*Sou

rce:

1987

Nat

iona

lM

edic

alE

xpen

ditu

reSu

rvey

(NM

ES)

;19

96–1

999

Med

ical

Exp

endi

ture

Pane

lSu

rvey

(ME

PS).

Age

ncy

for

Hea

lthca

reR

esea

rch

and

Qua

lity.

CI

indi

cate

sco

nfide

nce

inte

rval

. rates observed for 1987 and 1997 were not significantlydifferent from one another.

Overall, use of hospital-based outpatient services de-creased significantly between 1987 and 1999, with thepercent of children with at least one hospital outpatientvisit dropping significantly in the late 1990s compared to1987 (Table 2). Only 6.1% of children had at least onehospital outpatient visit in 1999, compared to 11.8% ofchildren in 1987, a 48% decrease. Throughout the late1990s, rates are observed to have continued a generaldownward trend, but differences between these annual es-timates were not significant. The drop-off from 1987 tothe late 1990s was significant for almost every subpopu-lation examined but was especially marked for publiclyinsured children (Figure 3), children 0–4 years of age,non-Hispanic other children, and children in the West (Ta-ble A-2).

Compared to 1987, the estimated proportion of childrenwith at least one inpatient stay was lower for each yearfrom 1996 through 1999 (Table 2). Overall, the percentof children with at least one hospital inpatient stay de-creased from 4.7% in 1987 to 2.6% in 1999, a decreaseof 45%. This drop-off was not consistent across all cate-gories of children (Figure 4). Significant reductions in theproportion of children with at least one inpatient stay wereobserved for privately insured children (from 4.6% to2.3%, a 50% decline), children living in families withfamily incomes $200% of poverty level (from 4.5% to2.0%, a 56% decline), and children in the Midwest (from6.0% to 1.8%, a 70% decline). The proportion of childrenwith a hospital inpatient discharge in the Midwest in 1987went from being somewhat higher than the values for allother regions to being somewhat lower than the values forall other regions in 1999. From 1996 to 1999, the percentof children with at least one inpatient discharge remainedstable.

As with hospital inpatient stays, compared to 1987, theestimated proportion of children with at least one ED visitwas lower for each year from 1996 through 1999 (Table2). Overall, the proportion of children with at least oneED visit declined from 17.1% in 1987 to 11.1% in 1999.Large declines in rates of ED use were found among pub-licly insured children (from 21.9% to 12.7%, a 42% de-crease), children below 200% of poverty level (from19.3% to 12.7%, a 34% decrease), and children in theNortheast (from 19.8% to 11.1%, a 44% decrease) (Figure5). Between 1996 and 1999, the proportion of childrenwith at least one ED visit dropped from 12.9% to 11.1%.Significant drops occurred for a number of subpopula-tions, including children aged 10 to 14 years, girls, whites,non-Hispanics, children not in poor health, children in ur-ban areas, and children 200% or more above the povertyline (Table A-4).

Overall, dental care use by children appears to haveincreased by a nonsignificant amount from 1987 to thelate 1990s (Table 2). In 1987, 40.1% of children had adental visit, compared to 42.1% in 1999.

Overall, the proportion of children with at least oneprescription did not change significantly between 1987


Figure 2. Office-based use for children 17 years of age and younger, by select population characteristics and year. Source: 1987 NationalMedical Expenditure Survey (NMES); 1996–1999 Medical Expenditure Panel Survey (MEPS). Agency for Healthcare Research and Quality.

Figure 3. Hospital outpatient use for children 17 years of age and younger, by select population characteristics and year. Source: 1987National Medical Expenditure Survey (NMES); 1996–1999 Medical Expenditure Panel Survey (MEPS). Agency for Healthcare Researchand Quality.


Figure 4. Hospital inpatient use for children 17 years of age and younger, by select population characteristics and year. Source: 1987National Medical Expenditure Survey (NMES); 1996–1999 Medical Expenditure Panel Survey (MEPS). Agency for Healthcare Researchand Quality.

Figure 5. Emergency Department use for children 17 years of age and younger, by selected population characteristics and year. Source:1987 National Medical Expenditure Survey (NMES); 1996–1999 Medical Expenditure Panel Survey (MEPS). Agency for Healthcare Researchand Quality.


and 1999 (Table 2). The proportion of children in fair orpoor health who received at least one prescription in-creased from 65.8% in 1987 to 85.2% in 1999, while theproportion for non-poor children decreased from 56.5%in 1987 to 52.2% in 1999. Significant changes were alsoobserved for other subpopulations (eg, children in theWest and children above and below 200% of the povertyline (Table A-6).

From 1987 to the late 1990s, the site of ambulatorycare shifted significantly toward office-based points ofservice and away from outpatient and ED points of ser-vice (Table 3a). The contribution of office-based visits tooverall ambulatory care utilization increased from 86.4%in 1987 to 92.0% in 1999. Most of this increase could beattributable to a decline in hospital outpatient utilization,from 7.3% to 3.7%.

Health Care Expenditures

The percent of total expenditures attributable to chil-dren decreased significantly from about 14% in 1987 toabout 10% in late 1990s (Figure 6). Estimates for chil-dren’s health care expenditures are presented below.

After adjusting for inflation, there were several note-worthy increases in expenditures by type of service be-tween 1987 and 1999 (Figure 7). For office-based servic-es, average annual expenditures per child (with expendi-tures) were significantly higher in the late 1990s (range,$272 to $295) compared to 1987 ($228). Average expen-ditures for hospital outpatient services were significantlyhigher in 1997 ($1087), 1998 ($1086), and 1999 ($1230)compared to 1987 ($840). In contrast, average expendi-tures for hospital inpatient services were similar in 1987compared to 1997, 1998, and 1999 ($7822 vs $8547,$6053, and $7590, respectively) (Table A-8). For ED ser-vices, average expenditures were significantly higher dur-ing the late 1990s (range from $395 to $530) comparedto 1987 ($277).

Between 1987 and the late 1990s, the proportion oftotal ambulatory care expenditures for children shiftedaway from hospital outpatient services and toward office-based services (Table 3b). In 1999, outpatient departmentservice expenditures accounted for 22.1% of all ambula-tory services expenditures for children, compared to33.0% in 1987, while it rose from 51.8% to 61.1% foroffice-based services. During the late 1990s, the distri-bution of expenditures to these ambulatory points of ser-vice remained relatively stable. There was no significanttrend in the distribution of sources of payment for totalhealth care expenditures during the late 1990s (Table A-9). Distributions of payment sources for the late 1990scould not be compared to the distribution for 1987 be-cause payment sources were not able to be defined in asimilar way.

Parent Reports of Children’s Quality of Care

Overall, parents’ reports of their experiences in access-ing care and with the actual care provided in 2001 showedeither improvement or no change compared to 2000. Par-ents’ reports on the first dimension, extent of problems in

accessing care, were largely similar in 2001 to 2000, withsome improvement for children with public-only insur-ance in receiving necessary care. In 2001, three quartersof children younger than 18 years of age were reported tohave had one or more visits to a doctor’s office or clinicduring the last 12 months (Table A-10). Among these chil-dren with one or more visits, 91.9% were reported to haveno problems receiving care that their parents or their doc-tors believed was necessary, a significant improvementfrom their experiences in 2000 (88.6% reporting not aproblem) (Figure 8). The gap in 2001 between privatelyinsured and publicly insured children who did not have aproblem in obtaining needed care (3.7 percentage pointdifference) narrowed from the 12.5 percentage point dif-ference in 2000 as a result of a significant increase (be-tween 2000 and 2001) in the percentage of reports of nothaving a problem in getting needed care for children withpublic-only coverage (9.9 percentage point increase).

Of those children needing to see a specialist (17.4% ofchildren younger than 18 years of age in 2001), getting areferral was reported as not a problem for more than 80%of these children (Figure 8; Table A-10). Getting a referralwas more likely to present a problem for children withpublic-only coverage, compared to uninsured children andchildren with private coverage (percent reporting not aproblem: 74.7% of children with public-only coverage;87.0% of uninsured children; and 85.5% of children withprivate coverage). None of these 2001 data were signifi-cantly different from the data reported in 2000.

Several differences were noted between 2000 and 2001in parents’ reports on the second dimension, quality of thecare provided. Overall results showed an increase in theproportion of children whose parents reported more pos-itive experiences in 2001 compared to 2000 (in 2001,71.1% said providers always listened carefully, 74.2%said providers always explained things clearly, and 73.6%said providers always showed respect) (Figure 9; Table A-10). The overall increase between 2000 and 2001 in healthproviders always listening carefully was largely attribut-able to increases in positive reports for children with pri-vate coverage and for uninsured children, in whom theincreases were larger for uninsured children than for chil-dren with private coverage. The larger improvement from2000 to 2001 for uninsured children and children withpublic-only coverage than for children with private insur-ance in health providers always explaining things clearlyand always showing respect contributed to the eliminationof any significant differences by insurance type in the pro-portion of children whose parents responded ‘‘always’’ forthese two items in 2001. Significant differences by insur-ance remained in 2001 in the proportion of children whoseparents reported negative experiences for all three items.Children with public-only coverage or uninsured childrenwere at least twice as likely as children with private in-surance to have parents report that providers never orsometimes listened carefully to them, explained thingscarefully, or showed them respect. For example, childrenwith public-only coverage (10.2%) or uninsured children(8.5%) were more than twice as likely to be reported to


Table 3a. Percent Distribution of Ambulatory Visits for Children 17 Years of Age and Younger by Year*

YearTotal Visits(in millions)

Percent Distribution of Ambulatory Visits (95% CI)

Office-Based Outpatient Department Emergency Department

19871996199719981999

241.6222.3217.5226.6238.0

86.4 (84.9, 87.9)90.1 (89.1, 91.1)90.2 (89.4, 91.1)90.8 (89.8, 91.8)92.0 (91.0, 93.1)

7.3 (6.1, 8.5)4.6 (3.7, 5.4)4.6 (3.8, 5.4)4.3 (3.4, 5.2)3.7 (2.9, 4.6)

6.3 (5.8, 6.8)5.3 (4.9, 5.8)5.2 (4.7, 5.6)4.9 (4.5, 5.4)4.2 (3.7, 4.7)

*Source: 1987 National Medical Expenditure Survey (NMES); 1996–1999 Medical Expenditure Panel Survey (MEPS). Agency for Health-care Research and Quality. CI indicates confidence interval.

Figure 6. Percent of total expenditures attributable to children 17 years of age and younger, by selected population characteristics andyear. Source: 1987 National Medical Expenditure Survey (NMES); 1996–1999 Medical Expenditure Panel Survey (MEPS). Agency forHealthcare Research and Quality.

have providers who never or sometimes explained thingsclearly to them, compared to children with private cov-erage (3.8%).

Utilization of Hospital Inpatient Services

Consistent with MEPS results that showed relativelystable estimates in overall inpatient services between 1996and 1999, analysis of overall changes in the prevalenceof hospital stays did not reveal any significant shifts overtime. The population ratio for children’s hospitalizationswas 93.4 hospitalizations per 1000 children in 1995, com-pared to 88.0 hospitalizations per 1000 children in 2000(Figure 10; Table B-1). One notable shift, however, oc-curred in the prevalence of hospitalizations among the 15–17-year-olds, with a decline from 50.4 hospitalizations per1000 adolescents in 1995 to 41.9 hospitalizations per 1000adolescents in 2000. This finding may be related to the

decline in hospitalizations as a result of pregnancy andchildbirth in this group. As with children’s hospitaliza-tions, the aggregate measures for adult hospitalizations didnot reveal any significant shifts over time.

As shown in Figure 11 and Table B-2, the overall LOSfor children from 1995 to 2000 did not change signifi-cantly (3.4 days in 1995 to 3.3 days in 2000). Subpopu-lation comparisons, however, revealed some changes inthe LOS for children’s hospitalizations. The length of hos-pital stays for children aged 1–4 years, 5–9 years, and10–14 years decreased between 1995 and 2000 (1–4years: 3.3 to 2.9 days; 5–9 years: 4.0 to 3.4 days; and 10–14 years: 4.8 to 4.2 days, respectively). Interestingly, themean LOS for 10–14-year-olds consistently is longer thanany other age group across time. Patterns in mean LOSover time also varied by expected payer and region. Themean LOS for hospitalizations billed to private insurance


Table 3b. Percent Distribution of Ambulatory Service Expenditures for Children 17 Years of Age and Younger by Year*

Year

TotalExpenditures(in millions)

Percent Distribution of Ambulatory Services Expenditures (95% CI)

Office-Based Outpatient Department Emergency Department

19871996199719981999

$18 795$22 683$22 884$21 983$24 096

51.8 (48.3, 55.2)60.1 (54.7, 65.6)62.3 (57.6, 67.0)64.1 (60.1, 68.1)61.1 (56.8, 65.5)

33.0 (29.2, 36.8)19.9 (15.7, 24.1)21.6 (17.4, 25.7)21.4 (17.6, 25.3)22.1 (17.9, 26.4)

15.2 (13.8, 16.6)20.0 (14.4, 25.6)16.1 (13.5, 18.7)14.5 (12.6, 16.4)16.7 (13.4, 20.0)

*Source: 1987 National Medical Expenditure Survey (NMES); 1996–1999 Medical Expenditure Panel Survey (MEPS). Agency for Health-care Research and Quality. Expenditures are CPI-adjusted to 1999 dollars. CI indicates confidence interval.

Figure 7. Average expenditures per child 17 years of age and youn-ger, with expenditures for each type of health care service by year.Source: 1987 National Medical Expenditure Survey (NMES); 1996–1999 Medical Expenditure Panel Survey (MEPS). Agency forHealthcare Research and Quality.

increased from 1995 to 2000 (3.0 days to 3.1 days).Changes in the mean LOS for hospitalizations billed toMedicaid or categorized as uninsured did not have a sim-ilar trend. In addition, mean LOS for children’s hospital-izations increased in the West (2.7 days to 3.1 days from1996 to 2000).

The four most common reasons for hospitalizations byage group did not change over the time period examined.However, by delving deeper into the details of hospital-izations, some significant shifts over time were identifiedwithin each age group in the contribution each of thesemade to hospital utilization (Figure 12; Table B-3). Notsurprisingly, among infants younger than 1 year, birth wasthe most frequent reason for admission across all years(85.4% to 87.6% of all hospital stays). Respiratory con-ditions were consistently the second most prevalent set ofconditions, accounting for 4%–5% of all stays (data notshown). There was a decrease, however, in hospitaliza-tions due to pneumonia in this age group, with a high of1.5% in 1995 to a low of 0.9% in 2000.

In contrast to infants, approximately 40% of all hospitalstays for 1–4-year-olds were for respiratory conditionsthroughout this period (data not shown). Asthma, an am-bulatory care–sensitive (ACS) condition (ie, condition forwhich most hospital admissions could be avoided by ap-propriate outpatient care), became a more prevalent reasonfor admission between 1995 and 2000 (11.2% to 12.6%,respectively). However, the percentage of hospital stays

for pneumonia, another ACS condition, decreased duringthis time period (16.1% in 1995 and 14.0% in 2000).

Similar to 1–4-year-olds, hospitalizations due to respi-ratory conditions, including asthma and pneumonia, wereprominent among children 5–9 years of age, accountingfor 25%–30% of all admissions (data not shown). Asthma,the most common respiratory condition, accounted for10.3% of hospital stays in 1998, which was a decline fromthe previous year (13.4%). Since 1998, hospitalizationsdue to asthma have increased to 12.0% of all stays in2000. Hospitalizations due to pneumonia among 5–9-year-olds have declined since 1995. In 2000, 7.6% of all hos-pital stays were a result of pneumonia, down from 10.1%in 1995. In contrast, appendicitis, a nondiscretionary con-dition, became a more frequent principal diagnosis, ac-counting for 6.1% of hospital stays in 2000, up from 4.6%in 1995.

In addition to specific respiratory conditions, appendi-citis and affective disorders were frequent reasons for hos-pital admission throughout this time period among 10–14-year-olds. Similar to hospital stays for appendicitisamong 5–9-year-olds, the prevalence of hospital stays forappendicitis among 10–14-year-olds increased from 8.0%in 1995 to 9.1% in 2000. Exhibiting a more markedchange over time, affective disorders accounted for an in-creasing number of hospitalizations, rising from 5.3% in1995 to 8.3% in 2000. Hospitalizations due to pneumonia,in contrast, declined during this time period from 4.1% in1995 to 2.9% in 2000.

Among 15–17-year-olds, pregnancy was a common rea-son for admission to hospitals throughout the time period,accounting for 4%–6% of all hospital stays. A notablechange, however, occurred between 1995 and 2000. Preg-nancy was the most frequent reason for hospital admission(6.2% of all hospital stays) in this age group in 1995, butby 2000, pregnancy was only the third most frequent rea-son for admission (4.7% of hospital stays). This findingis in contrast to affective disorders, which was the thirdmost frequent reason for admission (5.0% of hospitalstays) in 1995 and the most frequent reason for admission(8.2% of hospital stays) in 2000.

In addition to changes in the relative frequency of age-specific conditions over time, the data from 1995 to 2000reveal that there were significant changes in the meanLOS for these conditions (Figure 13; Table B-4). Not sur-prisingly, among infants under 1 year of age, the longest


Figure 8. Problems for children 17 years of age and younger in receiving necessary care and in getting a referral to a specialist, 2000–01. Source: 2000–2001 Medical Expenditure Panel Survey (MEPS). Agency for Healthcare Research and Quality.

Figure 9. Experiences during care for children 17 years of age and younger, 2000–01. Source: 2000–2001 Medical Expenditure PanelSurvey (MEPS). Agency for Healthcare Research and Quality.


Figure 10. Trends in children and adolescent hospital discharges, by select population characteristics and year. Source: 1995–2000 Na-tionwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality.

Figure 11. Trends in mean length of stay (LOS) in days for children and adolescent hospital discharges, by selected population characteristicsand year. Source: 1995–2000 Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP). Agency for HealthcareResearch and Quality.


Figure 12. Trends in four most frequent age-specific principal diagnoses, 1995–00. Source: 1995–2000 Nationwide Inpatient Sample (NIS),Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality.

mean LOS was for other perinatal conditions (6.6 to 7.3days). No significant changes in LOS for any of theseconditions were noted across the 6 years. However, themean LOS for newborns increased from 2.8 days in 1995to 3.0 days in 2000. In contrast, the mean LOS for respi-ratory conditions declined between 1995 and 2000 (acutebronchitis: 3.3 to 3.0 days, respectively; pneumonia: 4.2to 3.6 days, respectively).

Similarly, among 1–4-year-olds, 5–9-year-olds, and10–14-year-olds, the mean LOS for respiratory conditionsdecreased between 1995 and 2000. The mean LOS forasthma declined by 0.3 days, and the mean LOS for pneu-monia declined by 0.5 days in all age groups. Althoughthe magnitude of change in the mean LOS is relativelysmall, the trend is consistent and linear. In addition, themean LOS for other frequent conditions in each age groupdecreased between 1995 and 2000. The most dramatic de-crease in mean LOS occurred for hospitalizations for chil-dren and youth 10–14 years of age with affective disor-ders. The mean LOS was 11.7 days in 1995, comparedwith 7.4 days in 2000, a decline of 4.3 days over a 6-yearperiod.

In contrast to the LOS among younger children andyouth, the mean length of hospital stays for three principalconditions among 15–17-year-olds increased significantly.The mean LOS for pregnancy, trauma to the perineum andvulva, and complications of pregnancy increased 0.2 to0.4 days over the 6-year time period. Although the mean

LOS for conditions related to pregnancy and the perineumsignificantly increased, the mean LOS for affective dis-orders significantly decreased from 9.4 days in 1995 to6.3 days in 2000.

DISCUSSION

For the first time, this report documents a number ofimportant changes in children’s health care for childrensince 1987. Utilization and expenditure trends encompassthe period from 1987 to 1999, whereas insurance andquality data are limited to trends during the mid- to late1990s. The last 15 years has been a time of numerouspolicy interventions at the state and Federal levels intend-ed to increase health insurance coverage for many ofAmerica’s low-income children20; it has also been a periodof change in the organization of health care, bringing anew focus on quality of care, substantial fluctuations inthe US economy, and a demographic trend toward an ag-ing society. Untangling the different effects of thesechanges on trends in children’s health care is challenging,but the data in this report can help point future analysesin some fruitful directions. This exploratory study is in-tended to inform both policymakers and researchers. Likeprevious reports, it provides a baseline from which tomeasure how future policy changes, alterations in theeconomy, and the health care delivery environment areaffecting children and their health care. In addition, thereport is meant to encourage future multivariate analyses


Figure 12. Continued.

of the data, with more detailed attention to specific causalfactors in the policy and delivery environments. Althoughdata on multiple dimensions of children’s health care areincluded in this report, our focus this year is on thosehealth care service changes over time, with particular em-phasis on insurance coverage, income, and geographic re-gion.

Health Insurance Coverage

This study adds to the growing body of evidence thatshows a decrease in the rate of uninsurance among chil-dren and youth.1,21 We restricted our analysis to the period1996–99 to focus attention on the impact of the passageof SCHIP. Other studies have reported on the trends be-tween 1987 and 1996, the time period during whichMEPS was not fielded, and found decreases in the pro-portion of uninsured children following earlier expansionsin the Medicaid program.20

Several complex issues, however, are hidden by thissimple conclusion of decreasing uninsurance rates. Firstis the issue of why uninsurance decreased and the relativecontributions of at least three factors to the decrease: im-plementation of SCHIP, welfare reform, and a strongeconomy. Consistent with other studies, our results indi-cate that most of the decrease in full-year uninsurance forchildren is accounted for by increases in private cover-age.22 In addition, in 2000, 17.5% of children were cov-ered for the entire year by public coverage, compared to15.4% in 1996 (before the introduction of SCHIP), a re-sult that is not significantly different. However, other in-vestigators’ findings show significant increases in partic-ipation in public programs.21,23,24 These increases in publicprogram participation appear to be more due to state ef-forts to increase enrollment rather than to eligibility ex-pansions for programs such as Medicaid and SCHIP, in-cluding reducing administrative barriers and expandingoutreach activities.

Second, these overall trends in uninsurance rates do notgive any insights into what might have happened hadthese state outreach and enrollment efforts and the passageof SCHIP not occurred. In fact, a recent study by Banthinand Selden20 estimates that in the absence of the Medicaid

expansions of the late 1980s and early 1990s, the percentof children uninsured for a full year would have increasedfrom 26% in 1987 to 32% in 1996. Our descriptive datacannot disentangle these disparate forces.

Third, our analysis does not examine the degree towhich the availability of public coverage may have sub-stituted or ‘‘crowded out’’ even greater increases in pri-vate coverage. A number of studies have examined thisissue, and while most reports point to some degree ofcrowd out, the exact size of this effect varies with the datasource and approach used, especially the choice of targetand control population.23,25 Indeed, the range of estimateson crowd-out range from 5% to 50%, with each estimatecapturing only a piece of this complex puzzle.6,23,26–28 Per-haps the current state of the literature on crowd-out is bestsummed up by a recent report as part of the Congressio-nally mandated evaluation of SCHIP, which concludedthat the ‘‘empirical evidence to inform the debate about‘crowd-out’ [. . . ] remains limited and equivocal.’’21

Finally, there continues to be ample evidence that amajority (at least 65%) of uninsured children are eligiblebut still not participating in public programs.22 Reasonsfor this include both system factors (such as programcharacteristics, connections to welfare, and geographic lo-cations; family factors, such as lack of information aboutthe availability of coverage, problems in the enrollmentprocess, not wanting public coverage or perceiving a needfor it, or problems maintaining coverage) and child char-acteristics (such as age, the presence of activity limita-tions, and whether they were born in the United States).22

A limitation of our analysis is that our data do not shedany light on the period from 1987 to 1996. However, trendsfor children’s insurance coverage during the period whenMEPS was not fielded are available from the US Census’sCurrent Population Survey (CPS) (www.census.gov/hhes/hlthins/historic/hihistt5.html). These data are not directlycomparable to MEPS or other sources of information be-cause of the different ways insurance questions are askedacross data collection efforts, even those in the Federal gov-ernment. In addition, comparing across years is difficult, assurvey items on insurance coverage change, often in ef-forts to improve accuracy of estimates (www.cbpp.org/9-21-01health.htm; www.census.gov/hhes/hlthins/historic/hihistt5.html). However, both MEPS20 and the CPS foundthat the percentage of uninsured children was higher in1996 than in 1987. From 1987 through 1992, CPS showedthe uninsurance rate for children was 12.7%–13.3%, de-pending on the year. Between 1992 and 1995, it hoveredbetween 13.7% and 14.2%, and in 1996 it rose to 14.8%.CPS shows steady declines in private health insurance cov-erage between 1987 and 1996, compensated by increasesin Medicaid coverage from 1987 through 1995, followedby a decline in Medicaid coverage beginning in 1996.

The challenge for the years ahead will be to preventthe deterioration in coverage as the gains that have beenmade are threatened by economic downturns.6 In 2003,states reduced eligibility (eg, Oklahoma reduced eligibilityfor 0–5-year-olds from 185% poverty level to 133% pov-erty level), reinstated monthly reporting of eligibility, and


Figure 13. Trends in mean length of stay (LOS) for age-specific principal diagnoses for children and adolescent hospital discharges, 1995–00. Source: 1995–2000 Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Re-search and Quality.

eliminated media outreach. In other words, the very strat-egies that brought children into these programs are beingreversed.

Health Care Utilization

This study can also shed some light on whether the goalof recent policy interventions has been achieved. That is,are children, particularly poor and publicly insured chil-dren, receiving more higher quality health care services?We first discuss the implications of these data for all chil-dren, then we examine the differences that emerge forpoor and publicly insured children.

In the area of use, the data actually show few overallincreases in utilization, while demonstrating that utiliza-tion has moved away from hospital outpatient and otherhospital-based services (inpatient and ED). The reductionsin inpatient and ED use are not surprising given the nu-merous policies and incentives that have been put in placeto reduce utilization in these settings. The changes mayeven point to more appropriate care for children (ie, anemphasis on primary care as a strategy to reduce pre-ventable hospitalizations and the development of medicalhomes for children).29

While the trend of decreasing hospital inpatient use isconsistent with most other studies, our results indicate thatthe magnitude of the decrease may be greater for childrenthan for adults.2–4 Our data show that hospital inpatient

use for children declined approximately 45% between1987 and 1999. In contrast, using the National HospitalDischarge Survey, Bernstein et al4 found that the rate ofhospital use decreased by only about 30% between 1985and 1998 for the population as a whole. Several clinicaland system factors may be contributing to this steep de-cline.30 For example, certain serious conditions of child-hood that often required hospitalization have been virtu-ally eliminated thanks to vaccines and ambulatory man-agement approaches that have emerged since 1987, in-cluding Haemophilus influenza B and oral rehydration forthe treatment of gastroenteritis.31 At the system level, it isnot clear to what extent children’s disproportionate partic-ipation in managed care may be contributing to this de-cline.3,32 Several studies have examined the impact ofmanaged care on hospitalizations, and a subset of thesehave focused on, or at least included, children.33–35 Ini-tially, these studies tended to show that HMOs decreasedhospital utilization in terms of both admission and LOS.35

The most recent review of this literature, however, con-cludes that ‘‘there was little evidence of differences inhospital admission rates for HMOs compared to non-HMOs.’’33 Studies limited to children have always pre-sented a mixed picture, depending on type of insurance.3

Indeed, a recent study by Weinick and Cohen36 usingMEPS found that while overall hospitalization rates diddecrease between 1987 and 1996, the difference in rates


Figure 13. Continued.

that existed in 1987 between Managed Care Organization(MCO) and non-MCO enrollees was eliminated in 1996,primarily as a result of reduction in hospitalizationsamong non-MCO enrollees. This finding was consistentacross demographic categories, including among 1–5-year-olds and 6–17-year-olds. Finally, other factors thatmay have contributed to the sharp decline in hospitaliza-tion rates include increasing cost sharing, utilization re-view, the use of alternative care settings, and the increas-ing use of same-day surgery.4 A number of recent studiesof hospital utilization for children have been conducted inindividual states37 or outside the United States and con-tinue to show a mixed picture of trends in hospital utili-zation, primarily depending on the age group exam-ined.31,36–40

Turning from hospitalization rates to LOS, the HCUPdata presented here revealed no overall trend toward areduction in LOS for children. In the aggregate, significantchanges in LOS were only evident for youths 1–4, 5–9,and 10–14 years of age, privately insured children, andchildren in the West. However, when the LOS was ex-amined for the four most frequent age-specific conditions,reductions in LOS were evident for specific respiratoryconditions (acute bronchitis, asthma, pneumonia), appen-dicitis, fluid and electrolyte disorders and, most notably,affective disorders. Indeed, hospitalizations for affectivedisorders showed a nearly 35% decline in LOS over a 6-year period, a finding consistent with other studies.41 In-creases in mean LOS were evident for newborns and thosewith conditions related to pregnancy and the perineumamong youths 15–17 years of age. Again, given that ourdata do not explicitly examine managed care practices, itis not clear what impact, if any, MCOs and their cost-containment strategies might be having on LOS for chil-dren, although the consistency in the results indicates thatsome policies are influencing the LOS for children in spe-cific areas. This remains a question for the population asa whole: results from 10 studies in one review were even-ly split as to whether they detected a significant reductionin LOS associated with HMO participation.33 At least one

of the studies included in this conclusion was focused onchildren.30

We also found that contributions that individual con-ditions made to overall inpatient hospital utilizationchanged over time. Although hospitalization rates by spe-cific conditions cannot be derived because population es-timates of children with these conditions are not available,the relative contributions that different diagnoses make tooverall hospital utilization can hint at the possibility thatsome changes in hospitalization rates by condition haveoccurred since 1995. For example, pneumonia accountedfor a smaller proportion of all hospitalizations in 2000 forchildren less than 15 years of age, and affective disordersaccounted for a larger proportion of all hospitalizations in2000 for youths 15–17 years of age. Further, relative to1998, asthma accounted for a larger proportion of hospi-talizations in 2000 for children under 10 years, a findingconsistent with numerous studies that have documentedincreasing rates of pediatric hospitalizations for asthmaduring earlier time periods.42,43 Clearly, the trends shownby the HCUP data could be due to either a real decreasein hospitalizations for respiratory conditions or to a rela-tive increase in hospitalizations for other conditions.

Our finding of significant reductions in ED use overalland for some subgroups contributes to the mixed picturepresented by much of the literature on ED utilizationtrends. Bernstein et al4 found that ED utilization remainedstable overall between 1990 and 1998 and suggested thatmanaged care requirements for preauthorization had failedto lower ED utilization. Szilagyi, in his 1998 review,found that there were no data examining the impact ofmanaged care on ED utilization for privately insured chil-dren, whereas there appeared to be fairly consistent find-ings of continued trends toward lower ED utilizationamong publicly insured children.3 In that Szilagyi’s morerecent work on the impact of New York’s SCHIP program(CHPlus), he and his collaborators found that implemen-tation of CHPlus was not associated with any measurablechange in ED utilization by young children.37 In our study,ED utilization dropped for both publicly and privately in-sured children, but the magnitude of the decrease ap-peared greater for children with public coverage. Manyfactors that affect ED utilization are not included in ouranalysis but could be examined using MEPS, includingMCO membership, maternal health status,44 child partic-ipation in center-based child care,45 the quality and capac-ity of primary care services, including the type of medicalhome or the degree of continuity of the care,46–48 andchanges in the organization of care from ED sites to hold-ing sites or urgent care units. Finally, we should note thatcounts of ED services are significantly lower (by as muchas 40%) in MEPS than those in other national surveys(eg, the National Hospital Ambulatory Medical Care Sur-vey, NHAMCS) but are similar to estimates from anothernational household survey (eg, the National Health Inter-view Survey, NHIS). The large difference betweenMEPS/NHIS and NHAMCS is difficult to completely ex-plain, and further research on this is needed.49

Our results on the absence of any trends in utilization


of dental visits deserve some mention. First, the fact thatdental care use by children has been and remains low isno surprise to child health services researchers. This isparticularly the case for children with public-only cover-age and those children at ,200% poverty level, in whomthe proportion with a visit hovered between 25.7% and28.9% over the time period examined. However, to theextent that children are becoming insured thanks to publicinsurance programs, their dental care utilization patternsshould improve somewhat, since uninsured children havefared even worse over the same time period: the propor-tion with a visit has been between 18.7% and 22.0%. In-deed, most evaluations of the impact of the implementa-tion of SCHIP-like programs on dental care show sub-stantial increases in access to dental care.50–52

Finally, it would be interesting to tease out what, if any,difference in service mix utilization might have occurredsince the establishment of SCHIP, given that the benefitpackages and service provider networks established understand-alone SCHIP programs varied from traditional Med-icaid. A recent assessment of these arrangements revealedsurprisingly little difference between Medicaid and stand-alone SCHIP programs.53 Although our analysis combinedchildren covered under both Medicaid and SCHIP, suchan analysis would only be possible in future years, sinceSCHIP coverage was specifically probed for beginning in1999.

Expenditures

There were a number of significant trends in expendi-ture patterns for children since 1987. Health care expen-ditures for children as a proportion of overall US healthcare expenditures have remained relatively small since1987, exhibiting a drop from 13.6% in 1987 to 9.6% in1998. The actual total amount of expenditures on childrendid not increase significantly between 1996 and 1999.However, average expenditures per child (with expendi-tures and adjusted for inflation) increased significantly inthe late 1990s compared to 1987 for office-based services,hospital outpatient services, and ED services. Given thesignificant expansion of gatekeeping arrangements duringthis time period, it would be interesting to delve furtherinto whether children in these types of arrangements haddifferent expenditure patterns over time. Using the 1996MEPS, Pati et al54 concluded that for the 40 million chil-dren enrolled in gatekeeping plans, annual total per capitahealth expenditures differed by less than 1% for childrenin gatekeeping plans compared with those in indemnityplans.

Parent Reports of Children’s Quality of Care

Our data for quality of care are limited but suggestsome improvement between 2000 and 2001, particularlyfor children with public-only insurance, in always receiv-ing necessary care, and for uninsured, publicly insured,and privately insured children in the second dimension ofexperiences with having health providers who always ex-plain things clearly to their parents and who alwaysshowed respect for what their parents had to say. Indeed,

the larger improvement for uninsured and publicly insuredchildren than for children with private insurance in havinghealth providers who always explained things clearly andalways showed respect contributed to the elimination ofany significant differences in 2001 by insurance type inthe proportion of children with parents responding thathealth providers always explain things carefully and showrespect. Overall, about 30% of children had parents whoreported that their providers did not always listen carefullyto them, explain things well, or show them respect.

Focus on Low-Income and Publicly Insured Children

This country has made a concerted effort over the last15 years to improve health insurance coverage and accessto health care for low-income children. What can the datain this report tell us about how successful we have been?Given the descriptive nature of our analyses, we focushere on both low-income and publicly insured children.Overall, we conclude that low-income and publicly in-sured children are still less likely than their more well-offcounterparts to receive needed health care services,whether those are office visits, hospital outpatient visits,dental visits, or prescription medications in 2000. How-ever, the size of that gap may have narrowed over time.Access to dental care is one area where the gap betweenprivately and publicly insured children did not narrowover time. Fewer than 30% of either publicly insured orlow-income children had at least one dental visit in 1999.In contrast, in 1999, low-income children were both morelikely to have at least one hospital inpatient admission oran ED visit, and publicly insured children were more like-ly than privately insured children to have at least one hos-pital inpatient admission.

Turning from utilization to expenditures, it is interestingto note that the proportion of total expenditures attribut-able to publicly insured children has shifted downwardfrom 11.0% in 1987, reaching as low as 5.8% in 1998,and rebounding in 1999 to 7.1%. This change is comple-mented by the fact that despite expansions in public in-surance program eligibility and participation, the percentof expenditures paid for by Medicaid (including SCHIP)has remained relatively unchanged since 1996 (range:13.9% to 19.5%). Prior studies of health insurance expan-sions have documented some increases in costs, at leastin the short term, as newly enrolled children consumemore services initially, an indication of pent-up de-mand.50,55–57 However, the study by Gordon and Selden56

on the Medicaid eligibility expansions between 1984 and1994 found that the relatively low incremental cost perenrollee was substantially below the average Medicaid ex-penditure for children. This was attributed to the fact thatexpansion children tended to be older and have fewer dis-abilities.

Although not all uninsured children are low income, itis interesting to note that children who remained withoutcoverage in the late 1990s appeared to experience wors-ening access to care, as measured by a statistically sig-nificant decline in having at least one office visit. Unin-sured children continued to have lowest expenditures


($2.7 billion, or 4.5% of all expenditures for children in1999) and paid the greatest proportion of their health careexpenditures out of pocket (35.7% in 1999).

The minimal improvements in health care for publiclyinsured children are also reflected in our data on parentalreports of their children’s quality of care. About 25% ofpublicly insured children had parents who reported thatgetting a referral was likely to present a small or big prob-lem, significantly more than uninsured and privately in-sured children. Publicly insured children were also stillless likely than privately insured children to have parentsreport that their children’s health providers always listenedcarefully, and together with uninsured children, they weretwice as likely as privately insured children to have par-ents report that providers never/sometimes showed respectfor what they had to say (9.8%, 8.7%, and 4.2%, respec-tively).

Future Years

Future years’ worth of these data should provide a ful-ler picture of the impact of very recent changes in healthcare financing and delivery, US demographics, and theever-changing economy. Continuing to track trends incoverage, use, expenditures, and quality is important asvarious policy changes are implemented, including Fed-eral waivers for states to provide coverage to adults,whether or not they have covered children.6 MEPS andHCUP, perhaps combined with other data on relevant pol-icy and economic changes, are both ripe for further de-tailed, hypothesis-driven analyses of questions raised bythe descriptive data in this article. For example, do im-provements in preventive care or some other factor, suchas increased per–hospital-event costs account for the de-clining use of hospital-based services, including ED vis-its? Why was the drop in hospital outpatient visits moremarked for publicly insured children? What accounts forthe regional differences in trends in hospital inpatientstays? Why haven’t dental visits increased, and if theyhave increased in certain places, what accounts for thechanges? How can the lack of overall change in prescrip-tion drug use be explained? What accounts for the in-creased use over time between children in fair or poorversus good to excellent health? On the expenditure side,why do children’s personal health expenditures accountfor a lower percentage of total health expenditures in thelate 1990s than in the late 1980s? Can this change beexplained by less use of inpatient services among childrenalone, or did other factors contribute? On the hospital in-patient side, what accounts for the increases in asthma,appendicitis, and affective disorders hospitalizations andthe decreases in childhood pneumonia and teen pregnancyhospitalizations? What affects might various trends haveon children’s health status? Beginning in 2001, data fromthe revised MEPS child health supplement (www.meps.ahrq.gov/DatapPub/questionnaires) can help shed furtherlight on the relationships between trends in access, cov-erage, utilization, expenditures, and aspects of children’shealth status. On the quality front—measures of parent-reported patient experiences of care—more needs to be

understood about the impact of having parents report onolder children’s care and the underlying issues reflectedin parents’ (or children’s) reporting.

In future iterations of this report, we will focus on racialand ethnic disparities among children, although interestedreaders can glean some data on disparities from the elec-tronic pages of this journal. Beginning at the end of 2003,the AHRQ began two new annual reports on the qualityof health care and on prevailing disparities in health caredelivery. Even with these reports, data gaps will likelyremain in our ability to characterize and understand carefor children and youth. In future years, this report willexplore different policy-relevant issues in health care forchildren.

ACKNOWLEDGMENTS

The views expressed in this article are those of the authors anddo not necessarily represent those of the AHRQ or the US Depart-ment of Health and Human Services. The authors gratefully ac-knowledge the programming support provided by Suzanne Worthand her colleagues at Social and Scientific Systems and Sean Sextonfor his expert graphics and editorial assistance. The authors alsowould like to thank the individual state data collection projects thatare partners in the Healthcare Cost and Utilization Project (HCUP)and without which HCUP would not be possible: Arizona Depart-ment of Health Services, Phoenix, Ariz; California Office of State-wide Health Planning and Development, Sacramento, Calif; Colo-rado Health and Hospital Association, Greenwood Village, Colo;Connecticut Integrated Health Information (Chime Inc), Walling-ford, Conn; Florida Agency for Health Care Administration, Talla-hassee, Fla; Georgia: An Association of Hospitals & Health Systems(GHA), Marietta, Ga; Hawaii Health Information Corporation, Hon-olulu, Hawaii; Illinois Health Care Cost Containment Council,Springfield, Ill; Iowa Hospital Association, Des Moines, Iowa; Kan-sas Hospital Association, Topeka, Kans; Kentucky Department forPublic Health, Frankfort, Ky; Maine Health Data Organization, Au-gusta, Maine; Maryland Health Services Cost Review Commission,Baltimore, Md; Health Data Policy Group, Boston, Mass; MichiganHealth & Hospital Association, Lansing, Mich; Missouri HospitalIndustry Data Institute, Jefferson City, Mo; New Jersey Departmentof Health and Senior Services, Trenton, NJ; New York State De-partment of Health, Albany, NY; North Carolina Department ofHealth and Human Services, Chapel Hill, NC; Oregon Associationof Hospitals and Health Systems, Lake Oswego, Ore; Office ofOregon Health Policy and Research, Salem, Ore; PennsylvaniaHealth Care Cost Containment Council, Harrisburg, Pa; South Car-olina State Budget and Control Board, Columbia, SC; TennesseeHospital Association, Nashville, Tenn; Texas Health Care Informa-tion Council, Austin, Tex; and the Utah Department of Health, SaltLake City, Utah; Virginia Health Information, Richmond, Va; Wash-ington State Department of Health, Olympia, Wash; West VirginiaHealth Care Authority, Charleston, WV; and the Wisconsin Depart-ment of Health and Family Services, Madison, Wisc.

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APPENDIX A

Appendix A provides additional information on theMedical Expenditure Panel Survey (MEPS) analyses, in-cluding the detailed tables on the changes over time ininsurance coverage, utilization, expenditures, and qualityof care (Tables A-1 to A-10) and narrative and updatedtables for the most recent year available (Tables A-11 toA-16). All methods for MEPS analyses and narrative re-sults on changes over time are described in the main bodyof the article.

Results on Most Recent Year Available

Insurance Coverage

In the first half of 2001, 63.1% of children were cov-ered by private insurance, 22.3% through public sources,and 14.6% were uninsured (Table A-11). As in previousyears, the highest rates of uninsurance were among ado-lescents (18.0%), Hispanic children (29.0%), and childrenin the South and West (18.4% and 17.0%, respectively).

Utilization

The patterns of health care use by children and adoles-cents in 1999 were similar to those from 1998, and there-fore, these data are included in the electronic appendix(Tables A-12 and A-13). Seventy percent of children hadat least one office visit in 1999, and for those with anyvisit, the average number was 4.3 visits per year. Only asmall percent had a hospital outpatient visit (6.1%), with

an average of 2.0 visits per child with any visits. Only2.6% of children and youth experienced a hospital stay(excluding stays for normal births), with an average of 1.2discharges for those with any hospital stays. A higher pro-portion experienced an emergency department (ED) visit(11.1%), with an average of 1.2 visits for those with anyED visit. Less than half (42.1%) of all children and youthhad a dental visit, with an average of 2.7 visits for thosewho visited a dentist at least once during the year. Finally,about half (50.3%) of all children obtained prescriptionmedicines, with an average of 4.2 prescriptions for thosewith any prescription use. Fewer uninsured children hadat least one office visit (43%) than did children with pub-lic (68.6%) or private coverage (73.6%), and for thosewith a visit, the average (2.7) was also less than for chil-dren with public (4.0) or private coverage (4.5). A similarpattern was evident in the proportion of children with adental visit. Less than 20% of uninsured children had atleast one dental visit, compared to 27.5% for publicly in-sured children and 48.8% for privately insured children.

Poor children (,200% poverty level) were less likelythan non-poor children to have at least one office visit(63.9% vs 74.2%), a hospital outpatient visit (5.0% vs6.9%), a dental visit (26.9% vs 52.2%), or a prescription(47.3% vs 52.2%) but were more likely to have at leastone hospital inpatient admission (3.6% vs 2.0%) or an EDvisit (12.7% vs 10.1%). Some regional differences in theproportion of children with at least one visit were evident.In general, children in the West tended to have the lowestrates of utilization, but this value reached significanceonly for certain types of visits. For example, the propor-tions of children with at least one office visit, one hospitaloutpatient visit, or one prescription were all significantlylower in the West than the Northeast, and the proportionof children with at least one ED visit was significantlylower in the West than either the Midwest or South.

Expenditures and Source of Payment

The data on expenditures for children’s health care in1999 were similar to those for 1998 (Table A-14). Themajority (83.6%) of American children had expendituresfor medical care during 1999, and average total expendi-ture for a child with any medical expenditure was $1013.The percent of children with any expenditure decreasedwith age from 87.4% for children 0–4 years of age to79.5% for children aged 15–17 years. Fewer African-American, non-Hispanic, and Hispanic children had anyexpenditures (71.6% and 71.9%) compared to White, non-Hispanic children. The highest average total expenditureper child was among children in fair or poor health($4456). Average expenditures for each type of healthcare service were $295 for office visits, $1230 for hospitaloutpatient visits, $7590 for hospital inpatient admission,$520 for an ED visit, $467 for a dental visit, and $153for prescribed medicines (Table A-15). Average expen-ditures for office visits were significantly lower for public-only ($216) and uninsured ($199) children than privatelyinsured children ($322).

Overall medical expenditures for children under 17


years of age totaled $61.5 billion in 1999. About 78% ofexpenditures were for privately insured children ($47.6billion), 18.1% for publicly insured children ($11.2 bil-lion), and 4.5% for uninsured children ($2.7 billion) (Ta-ble A-16). As in previous years, slightly more than half(50.9%) of these expenditures were paid for by privateinsurance, 17.1% by Medicaid, and 22.7% were paid outof pocket. Thus, the total dollar amount paid out of pocketfor children’s health care was about $14 billion. The av-erage out-of-pocket expenditures per child with any ex-penditure was about $230.

A higher proportion of health care expenditures againwere paid out of pocket for uninsured children (35.7%)than for those children who were either privately insured(25.4%) or publicly insured (7.8%).

APPENDIX B

Appendix B provides additional information on Health-care Cost and Utilization Project (HCUP) analyses, in-cluding detailed tables on trends in children’s hospitaliza-tions (Tables B-1 to B-4) and the narrative results andupdated tables for the year 2000 (Tables B-5 to B-10).Methods for the HCUP trend analyses and narrative re-sults are described in the main body of the article.

Methods for Most Recent Year Available

Data for the most recent year available come from the2000 State Inpatient Databases (SID) and the 2000 Na-tionwide Inpatient Sample (NIS). (Participating states inthe 2000 SID included Arizona, California, Colorado,Connecticut, Florida, Georgia, Hawaii, Illinois, Iowa,Kansas, Kentucky, Maine, Maryland, Massachusetts,Michigan, Missouri, New Jersey, New York, North Car-olina, Oregon, Pennsylvania, South Carolina, Tennessee,Texas, Utah, Virginia, Washington, West Virginia, andWisconsin.) The unit of analysis for these databases is thedischarge or hospital stay, rather than the patient. TheSID, which generally covers all inpatient stays in com-munity hospitals in participating states (the 28 states inthe 2000 NIS were Arizona, California, Colorado, Con-necticut, Florida, Georgia, Hawaii, Illinois, Iowa, Kansas,Kentucky, Maine, Maryland, Massachusetts, Missouri,New Jersey, North Carolina, New York, Oregon, Penn-sylvania, South Carolina, Tennessee, Texas, Utah, Virgin-ia, Washington, West Virginia, and Wisconsin) was usedto complete updated state descriptive statistics. The NIS,which has a sampling frame of more than 80% of all UShospital discharges, was used to complete regional andnational descriptive statistics.

Measures

In addition to information about length of stay, diag-noses, and expected payer described in the main body ofthe text, analyses for the most recent year available in-cluded information about the emergency department (ED)as the admission source and details about hospital char-acteristics.

Hospital Characteristics

Four variables on hospital characteristics, including lo-cation, teaching status, bed size, and ownership, were ob-tained form the American Hospital Association AnnualSurvey of Hospitals. Because the definitions of teachingstatus, bed size, and ownership have changed over thecourse of the years, we used the definitions prior to 1998for the purpose of examining trends in hospital character-istics in the future.

The location of the hospital was self-reported by thehospital as either urban (metropolitan) or rural (nonmet-ropolitan). A hospital was classified as a teaching insti-tution if the hospital has an intern-to-bed ratio of greaterthan zero and if the hospital is either a member of theCouncil of Teaching Hospitals or has an American Med-ical Association–approved residency program.

The size of the hospital was based on the number ofhospital beds, hospital location, and teaching status. Ahospital was considered small if it had 1–49 beds and waslocated in a rural area; 1–99 beds and was an urban, non-teaching hospital; or 1–299 beds and was an urban, teach-ing hospital. A hospital was considered medium if it had5–99 beds and was located in a rural area; 100–199 bedsand was an urban, non-teaching hospital; or 300–499 bedsand was an urban, teaching hospital. A hospital was con-sidered large if it had 1001 beds and was located in arural area; 2001 beds and was an urban, non-teachinghospital; or 5001 beds and was an urban, teaching hos-pital.

Ownership was based on the hospital’s response to thequestion of the type of organization that is responsible forestablishing policy for overall operation of the hospital:private, not-for-profit; private, for-profit; or government,non-Federal.

Analysis

The number of cases in the NIS was multiplied by hos-pital-specific discharge weights to derive regional and na-tional estimates of the number of discharges in 2000. Thenumber of cases from the SID remained unweighted. Chi-square tests and analysis of variance tests were used toassess statistically significant differences for categoricaland continuous data, respectively. All differences dis-cussed in the appendix for results based on the NIS arestatistically significant a the .05 level or better.

Results of Most Recent Year Available

Number, Length of Stay, and Admission Sourceof Hospitalizations

Hospitalizations of children and adolescents under 18years of age accounted for 17.5% of all hospitalizationsin the United States, or about 6.3 million discharges in2000 (Table B-5), similar to results obtained for previousyears. Because of the large number of in-hospital births,the majority of hospital stays for children and adolescentswere for infants younger than 1 year of age (73.6%).Mean length of stay (LOS) was 3.3 days for children andadolescents in US community hospitals, compared to 4.9


days for adults. As in prior years, significant variation inmean LOS was evident by age group (range: 2.9 to 4.2days) (Table B-5) and region (range: 3.1 to 3.5 days) (Ta-ble B-6). Overall, 14.6% of all pediatric hospital admis-sions were through the ED, although this also varied sig-nificantly by age (4.7% for ,1-year-olds to 46.1% for 5–9-year-olds) (Table B-5) and region (13.6% in the Southto 17.6% in the Northeast) (Table B-6).

Expected Payer

As was the case in previous years, more than half(54.5%) of hospitalizations for children and adolescentswere billed to private insurers, 37.8% to Medicaid, and5.1% were uninsured (Table B-5). The proportion of hos-pitalizations billed to Medicaid or labeled as uninsuredvaried significantly by age of the children and adolescent(Table B-5) and region of the country (Table B-6). Forexample, Medicaid was billed for 31.8% of hospital staysin the Midwest, compared with 43.0% in the South. Un-insured hospitalizations ranged from 3.9% in the North-east to 6.8% in the South.

Table B-7 provides additional information on expectedpayers. The mean LOS was significantly shorter for un-insured child hospitalizations (2.7 days) compared withprivately insured child hospitalizations (3.1 days) and hos-pitalizations of children covered by Medicaid (3.7 days).A significantly larger proportion of uninsured children’shospitalizations listed the ED as the source of admission(19.4%), compared with hospitalizations of children cov-ered by Medicaid (17.0%) and private insurance (12.4%).

Types of Hospitals

For the entire nation, 54.9% of hospital admissions oc-curred in large hospitals, 28.9% in medium hospitals, and16.3% in small hospitals (Table B-8). The percentage ofhospital stays in large hospitals varied significantly by re-gion. The South relied primarily on large hospitals(65.0%) for children’s inpatient care, whereas the North-east treated children in large hospitals less than half thetime (43.9%). More child hospitalizations were managedby private, not-for-profit hospitals than by any other hos-pital type, but there was significant regional variation. Forexample, in the Northeast, very few hospitalizations oc-curred in private, for-profit (2.3%) or government, non-Federal (3.2%) hospitals, whereas hospital stays in theSouth and West occurred in private, for-profit and gov-ernment, non-Federal hospitals over one third of the time(South: 18.6% and 19.1%, respectively; West: 13.4% and20.6%, respectively). Less than half of all children andyouth hospital stays occurred in teaching hospitals(35.2%). As reported previously, more hospital stays for1–4-, 5–9-, and 10–14-year-olds (range: 40.2% to 43.4%)were in teaching hospitals, compared with infants and 15–17-year-olds (33.7% and 34.4%, respectively) (TableB-5).

Reason for Admission

Table B-9 provides the most frequent principal condi-tions treated in the United States, organized by body sys-tem or general condition, and Table B-10 provides break-downs on the top 10 conditions by age group. As in pre-vious years, nearly all infants younger than 1 year of agewere in the hospital for conditions related to the perinatalperiod, including diagnoses pertaining to newborns(90.1%). Respiratory conditions were the only other cat-egory of conditions that accounted for a sizeable percent-age of infant hospital stays (4.3%) (Table B-9), generallyfor acute bronchitis, asthma, and pneumonia (3.6% com-bined; Table B-10).

In contrast, approximately 40% of all hospital stays for1–4-year-olds were for respiratory conditions (Table B-9),including pneumonia (14.0%), asthma (12.6%), and acutebronchitis (5.5%) (Table B-10). Diseases of the digestivesystem also accounted for many hospital stays in this agegroup (10.8% of all hospital stays), primarily consistingof intestinal infections (4.0%) and noninfectious gastro-enteritis (3.2%). Other groups of conditions that account-ed for nearly 10% of all hospital stays among 1–4-year-olds included endocrine, nutritional, metabolic, and im-munity disorders (9.8% of stays) and injury and poisoning(9.5% of stays).

As was the case for hospital stays for 1–4-year-olds,respiratory conditions were the principal reason for ad-mission (25.4% of all hospital stays) among 5–9-year-olds. This group of conditions consists primarily of asth-ma (12.0%) and pneumonia (7.6%). More prevalent thanin younger child hospital stays, injury and poisoning, in-cluding fracture of the upper limb (3.2%), accounted for14.7% of hospital stays among 5–9-year-olds. In addition,diseases of the digestive system (14.0%) were a prevalentreason for admission in this age group. Appendicitis(6.1% of hospital stays) and noninfectious gastroenteritis(2.1%) were the largest contributors to this group.

Almost half of all hospital stays among 10–14-year-olds were attributable to one of three conditions: injuryand poisoning (16.8%), mental disorders (15.5%), and thedigestive system problems (15.2%). Limb fractures, spe-cifically of the upper limb (2.3%) and lower limb (3.0%),were the most common specific conditions under the cat-egory of injury and poisoning. Affective disorders (8.3%),the second most prevalent specific reason for admission,were the largest contributors to hospital mental disorders.Appendicitis (9.1%), the most prevalent specific reasonfor admission, contributed to diseases of the digestive sys-tem.

As in previous years, pregnancy, childbirth, and the pu-erperium accounted for over one third of hospital staysamong 15–17-year-olds (37.2%). Mental disorders(14.5%), primarily affective disorders (8.2%), and injuryand poisoning (13.8%) remained prevalent reasons for ad-mission.

Tab

leA

-1.

Offi

ce-B

ased

Use

for

Chi

ldre

n17

Yea

rsof

Age

and

You

nger

byY

ear*

Cha

ract

eris

tic

1987

Perc

ent

With

Any

Vis

its95

%C

I

1996

Perc

ent

With

Any

Vis

its95

%C

I

1997

Perc

ent

With

Any

Vis

its95

%C

I

1998

Perc

ent

With

Any

Vis

its95

%C

I

1999

Perc

ent

With

Any

Vis

its95

%C

I

Tota

l70

.2(6

8.7,

71.7

)71

.5(7

0.0,

73.1

)68

.9(6

8.5,

71.4

)69

.9(6

7.3,

70.5

)70

.1(6

8.3,

71.9

)

Hea

lthin

sura

nce

cove

rage

Any

priv

ate

Publ

icon

lyU

nins

ured

74.0

63.5

52.3

(72.

5,75

.5)

(59.

8,67

.3)

(48.

1,56

.5)

76.2

66.8

50.7

(74.

4,78

.0)

(63.

9,69

.7)

(45.

6,55

.8)

73.5

65.9

54.7

(71.

6,75

.5)

(63.

0,68

.9)

(50.

8,58

.7)

72.6

66.3

48.8

(70.

7,74

.5)

(63.

1,69

.5)

(43.

9,53

.7)

73.6

68.6

43.0

(71.

5,75

.7)

(64.

9,72

.3)

(38.

2,47

.8)

Age

0–

4y

5–9

y10

–14

y15

–17

y

81.1

67.5

63.2

66.7

(79.

2,83

.1)

(65.

1,69

.8)

(60.

8,65

.6)

(64.

1,69

.2)

83.0

72.2

64.2

63.7

(80.

6,85

.3)

(69.

7,74

.7)

(61.

0,67

.3)

(60.

2,67

.3)

83.9

69.0

62.1

61.5

(82.

1,85

.7)

(66.

7,71

.4)

(59.

6,64

.6)

(58.

5,64

.5)

82.4

67.4

62.6

60.6

(79.

8,84

.9)

(64.

6,70

.2)

(59.

9,65

.3)

(57.

3,63

.9)

82.4

66.6

65.7

63.3

(80.

1,84

.6)

(63.

5,69

.7)

(62.

8,68

.5)

(60.

0,66

.7)

Sex M

ale

Fem

ale

69.8

70.5

(68.

2,71

.5)

(68.

7,72

.4)

71.8

71.2

(69.

7,73

.9)

(69.

3,73

.2)

69.2

70.7

(67.

3,71

.1)

(68.

8,72

.6)

68.4

69.4

(66.

4,70

.5)

(67.

3,71

.5)

70.4

69.8

(68.

3,72

.5)

(67.

4,72

.1)

Rac

e/E

thni

city

Whi

te,

non-

His

pani

cA

fric

anA

mer

ican

,no

n-H

ispa

nic

His

pani

cO

ther

,no

n-H

ispa

nic

76.1

53.1

61.3

55.4

(74.

5,77

.7)

(50.

0,56

.2)

(58.

0,64

.7)

(47.

7,63

.2)

77.3

59.0

62.6

61.5

(75.

5,79

.0)

(55.

1,63

.0)

(59.

3,65

.9)

(53.

9,69

.1)

76.4

54.7

61.5

59.8

(74.

6,78

.2)

(51.

7,57

.6)

(58.

6,64

.3)

(51.

8,67

.8)

75.9

53.5

58.6

58.5

(74.

1,77

.6)

(49.

2,57

.7)

(55.

8,61

.5)

(49.

9,67

.0)

76.1

57.0

60.1

65.3

(74.

1,78

.1)

(51.

9,62

.1)

(56.

8,63

.4)

(57.

4,73

.2)

Perc

eive

dhe

alth

stat

us

Exc

elle

nt,

very

good

,go

odFa

iror

poor

69.6

76.7

(67.

9,71

.2)

(71.

9,81

.5)

71.8

77.0

(70.

2,73

.3)

(69.

7,84

.3)

69.7

83.6

(68.

1,71

.2)

(78.

7,88

.4)

68.7

85.5

(67.

0,70

.3)

(79.

3,91

.7)

69.7

90.1

(67.

8,71

.5)

(85.

4,94

.8)

Reg

ion

Nor

thea

stM

idw

est

Sout

hW

est

75.4

76.2

62.5

71.4

(72.

4,78

.4)

(73.

7,78

.6)

(59.

7,65

.4)

(68.

5,74

.2)

76.7

76.0

68.9

66.9

(73.

9,79

.5)

(73.

5,78

.4)

(66.

2,71

.7)

(63.

3,70

.5)

72.2

74.8

67.3

67.2

(67.

9,76

.4)

(72.

4,77

.2)

(64.

7,69

.9)

(64.

0,70

.4)

72.4

73.5

64.9

67.3

(68.

1,76

.6)

(70.

3,76

.6)

(62.

2,67

.6)

(64.

4,70

.1)

78.5

71.9

66.2

67.5

(75.

2,81

.8)

(68.

1,75

.7)

(62.

8,69

.7)

(63.

7,71

.3)

MSA M

SAN

on-M

SA70

.669

.1(6

8.9,

72.3

)(6

5.7,

72.5

)72

.468

.1(7

0.7,

74.2

)(6

4.8,

71.5

)70

.069

.9(6

8.3,

71.8

)(6

7.5,

72.4

)69

.268

.0(6

7.4,

70.9

)(6

4.3,

71.7

)70

.668

.2(6

8.5,

72.6

)(6

4.2,

72.1

)

Pove

rty

stat

us

,20

0%of

pove

rty

line

$20

0%of

pove

rty

line

61.2

76.6

(59.

0,63

.4)

(75.

0,78

.1)

64.0

77.3

(61.

6,66

.3)

(75.

5,79

.1)

61.4

75.9

(59.

4,63

.5)

(74.

1,77

.8)

61.2

74.0

(58.

7,63

.8)

(72.

0,76

.0)

63.9

74.2

(61.

1,66

.7)

(72.

1,76

.3)

*Sou

rce:

1987

Nat

iona

lM

edic

alE

xpen

ditu

reSu

rvey

(NM

ES)

;19

96–1

999

Med

ical

Exp

endi

ture

Pane

lSu

rvey

(ME

PS).

Age

ncy

for

Hea

lthca

reR

esea

rch

and

Qua

lity.

CI

indi

cate

sco

nfide

nce

inte

rval

;M

SA,

met

ropo

litan

stat

istic

alar

ea.

Tab

leA

-2.

Hos

pita

lO

utpa

tient

Use

for

Chi

ldre

n17

Yea

rsof

Age

and

You

nger

byY

ear*

Cha

ract

eris

tic

1987

Perc

ent

With

Any

Vis

its95

%C

I

1996

Perc

ent

With

Any

Vis

its95

%C

I

1997

Perc

ent

With

Any

Vis

its95

%C

I

1998

Perc

ent

With

Any

Vis

its95

%C

I

1999

Perc

ent

With

Any

Vis

its95

%C

I

Tota

l11

.8(1

0.5,

13.0

)7.

3(6

.3,

8.2)

6.8

(6.0

,7.

5)6.

5(5

.6,

7.3)

6.1

(5.4

,6.

9)

Hea

lthin

sura

nce

cove

rage

Any

priv

ate

Publ

icon

lyU

nins

ured

11.9

14.3 7.2

(10.

5,13

.3)

(11.

6,17

.0)

(5.1

,9.

3)

7.8

7.3

3.7

(6.7

,8.

9)(5

.6,

8.9)

(2.1

,5.

3)

7.1

7.9

2.6

(6.2

,7.

9)(6

.3,

9.5)

(1.5

,3.

7)

6.4

8.6

1.9

(5.4

,7.

5)(6

.8,

10.4

)(0

.9,

2.9)

6.6

5.8

3.1

(5.6

,7.

5)(4

.5,

7.1)

(1.5

,4.

6)

Age

0–

4y

5–9

y10

–14

y15

–17

y

15.9

10.4 8.6

11.8

(13.

6,18

.3)

(8.7

,12

.1)

(7.3

,9.

9)(9

.7,

13.8

)

9.7

6.2

5.9

7.2

(8.0

,11

.4)

(4.8

,7.

6)(4

.4,

7.4)

(5.4

,9.

1)

9.1

5.2

5.9

7.1

(7.5

,10

.7)

(4.1

,6.

2)(4

.6,

7.2)

(5.6

,8.

6)

7.5

6.9

5.5

5.7

(5.8

,9.

1)(5

.4,

8.3)

(4.1

2,7.

0)(4

.0,

7.3)

5.8

6.1

6.7

5.8

(4.6

,7.

1)(4

.8,

7.3)

(5.3

,8.

1)(4

.0,

7.6)

Sex M

ale

Fem

ale

11.8

11.8

(10.

3,13

.3)

(10.

4,13

.1)

7.4

7.0

(6.2

,8.

6)(5

.7,

8.3)

7.4

6.0

(6.4

,8.

5)(5

.2,

6.9)

6.5

6.4

(5.4

,7.

6)(5

.2,

7.6)

6.3

6.0

(5.2

,7.

3)(5

.0,

7.0)

Rac

e/E

thni

city

Whi

te,

non-

His

pani

cA

fric

anA

mer

ican

,no

n-H

ispa

nic

His

pani

cO

ther

,no

n-H

ispa

nic

12.2

11.7 9.8

9.9

(10.

9,13

.5)

(9.3

,14

.0)

(7.2

,12

.4)

(5.0

,14

.8)

8.3

5.4

4.9

6.3

(7.1

,9.

5)(3

.4,

7.3)

(3.6

,6.

3)(3

.0,

9.7)

7.4

6.2

4.9

5.6

(6.4

,8.

4)(4

.5,

8.0)

(3.9

,5.

9)(1

.6,

9.6)

7.2

5.4

5.3

3.4

(6.0

,8.

4)(3

.4,

7.3)

(3.8

,6.

8)(0

.2,

6.5)

7.2

4.5

4.4

2.9

(6.2

,8.

2)(2

.9,

6.0)

(3.1

,5.

7)(0

.8,

4.9)

Perc

eive

dhe

alth

stat

us

Exc

elle

nt,

very

good

,go

odFa

iror

poor

10.5

22.2

(9.4

,11

.6)

(18.

0,26

.4)

6.9

18.3

(6.0

,7.

8)(1

2.1,

24.6

)6.

417

.8(5

.7,

7.2)

(12.

6,23

.0)

6.0

21.1

(5.2

,6.

9)(1

2.9,

29.3

)5.

918

.1(5

.1,

6.6)

(10.

8,25

.3)

Reg

ion

Nor

thea

stM

idw

est

Sout

hW

est

13.9

12.4 9.9

12.5

(11.

9,15

.8)

(10.

3,14

.4)

(7.3

,12

.5)

(9.9

,15

.1)

9.3

9.5

5.0

6.7

(6.8

,11

.9)

(7.4

,11

.6)

(3.6

,6.

3)(5

.4,

8.0)

9.1

8.3

6.2

4.3

(7.4

,10

.8)

(6.5

,10

.1)

(5.0

,7.

4)(3

.0,

5.5)

8.3

7.8

5.5

5.0

(6.5

,10

.1)

(5.7

,9.

8)(4

.4,

6.6)

(2.9

,7.

2)

8.3

7.2

5.5

4.4

(6.3

,10

.3)

(5.7

,8.

8)(4

.2,

6.7)

(3.1

,5.

7)

MSA M

SAN

on-M

SA12

.111

.0(1

1.0,

13.1

)(7

.5,

14.5

)7.

27.

4(6

.2,

8.2)

(5.3

,9.

6)6.

77.

2(5

.9,

7.5)

(5.3

,9.

0)6.

56.

3(5

.4,

7.5)

(4.9

,7.

8)6.

16.

1(5

.3,

6.9)

(4.5

,7.

7)

Pove

rty

stat

us

,20

0%of

pove

rty

line

$20

0%of

pove

rty

line

12.4

11.3

(10.

3,14

.5)

(10.

1,12

.5)

6.3

8.0

(5.2

,7.

4)(6

.8,

9.1)

6.0

7.3

(5.0

,6.

9)(6

.3,

8.3)

6.3

6.5

(5.3

,7.

3)(5

.3,

7.7)

5.0

6.9

(4.0

,5.

9)(5

.9,

7.9)

*Sou

rce:

1987

Nat

iona

lM

edic

alE

xpen

ditu

reSu

rvey

(NM

ES)

;19

96–1

999

Med

ical

Exp

endi

ture

Pane

lSu

rvey

(ME

PS).

Age

ncy

for

Hea

lthca

reR

esea

rch

and

Qua

lity.

CI

indi

cate

sco

nfide

nce

inte

rval

;M

SA,

met

ropo

litan

stat

istic

alar

ea.

Tab

leA

-3.

Hos

pita

lIn

patie

ntU

sefo

rC

hild

ren

17Y

ears

ofA

gean

dY

oung

erby

Yea

r*

Cha

ract

eris

tic

1987

Perc

ent

With

Any

Dis

char

ges

95%

CI

1996

Perc

ent

With

Any

Dis

char

ges

95%

CI

1997

Perc

ent

With

Any

Dis

char

ges

95%

CI

1998

Perc

ent

With

Any

Dis

char

ges

95%

CI

1999

Perc

ent

With

Any

Dis

char

ges

95%

CI

Tota

l4.

7(4

.1,

5.3)

2.9

(2.4

,3.

5)2.

7(2

.3,

3.2)

2.9

(2.5

,3.

4)2.

6(2

.1,

3.1)

Hea

lthin

sura

nce

cove

rage

Any

priv

ate

Publ

icon

lyU

nins

ured

4.6

6.4

3.0

(4.0

,5.

3)(4

.8,

7.9)

(1.8

,4.

2)

2.4

5.4

1.9

(1.8

,2.

9)(3

.9,

6.8)

(0.8

,3.

0)

2.4

4.2

2.1

(1.9

,2.

9)(3

.2,

5.2)

(0.8

,3.

4)

2.7

4.1

2.2

(2.1

,3.

3)(3

.1,

5.1)

(0.9

,3.

5)

2.3

4.1

2.0

(1.8

,2.

8)(2

.9,

5.2)

(0.7

,3.

3)

Age

0–

4y

5–9

y10

–14

y15

–17

y

9.7

2.0

1.8

5.0

(8.3

,11

.2)

(1.4

,2.

7)(1

.2,

2.4)

(3.7

,6.

3)

5.2

2.1

1.0

3.8

(4.0

,6.

3)(1

.2,

3.0)

(0.5

,1.

5)(2

.5,

5.1)

5.6

1.5

1.3

2.6

(4.3

,6.

8)(1

.0,

1.9)

(0.8

,1.

8)(1

.7,

3.5)

5.1

1.7

1.7

3.6

(4.0

,6.

1)(0

.9,

2.5)

(1.1

,2.

2)(2

.3,

4.9)

5.2

1.6

1.2

2.7

(4.1

,6.

3)(0

.8,

2.3)

(0.7

,1.

8)(1

.2,

4.1)

Sex M

ale

Fem

ale

4.4

5.1

(3.7

,5.

0)(4

.3,

5.9)

2.9

3.0

(2.2

,3.

6)(2

.2,

3.8)

3.0

2.4

(2.4

,3.

7)(1

.9,

2.9)

3.3

2.6

(2.6

,3.

9)(1

.9,

3.3)

3.2

2.0

(2.5

,4.

0)(1

.4,

2.6)

Rac

e/E

thni

city

Whi

te,

non-

His

pani

cA

fric

anA

mer

ican

,no

n-H

ispa

nic

His

pani

cO

ther

,no

n-H

ispa

nic

5.0

4.6

4.0

2.8

(4.3

,5.

6)(3

.4,

5.7)

(2.3

,5.

7)(0

.7,

5.0)

2.8

3.5

3.3

1.4

(2.2

,3.

5)(2

.0,

5.0)

(2.1

,4.

5)(0

.2,

2.9)

2.6

3.6

2.8

1.2

(2.0

,3.

2)(2

.4,

4.8)

(2.1

,3.

5)(0

.1,

2.3)

2.9

3.2

3.1

1.9

(2.2

,3.

6)(2

.0,

4.4)

(2.2

,3.

9)(0

.0,

3.9)

2.6

2.2

2.9

4.1

(2.0

,3.

2)(1

.2,

3.1)

(2.0

,3.

8)(1

.0,

7.2)

Perc

eive

dhe

alth

stat

us

Exc

elle

nt,

very

good

,go

odFa

iror

poor

3.0

9.3

(2.5

,3.

5)(6

.6,

12.0

)2.

613

.2(2

.0,

3.1)

(7.7

,18

.8)

2.2

14.6

(1.8

,2.

6)(1

0.1,

19.1

)2.

611

.6(2

.2,

3.0)

(6.1

,17

.1)

2.2

14.2

(1.7

,2.

7)(7

.1,

21.3

)

Reg

ion

Nor

thea

stM

idw

est

Sout

h

4.7

6.0

4.2

(3.4

,5.

9)(4

.9,

7.0)

(3.3

,5.

2)

2.3

3.5

3.3

(1.4

,3.

2)(2

.4,

4.7)

(2.3

,4.

4)

1.9

3.5

3.1

(1.1

,2.

7)(2

.4,

4.6)

(2.4

,3.

9)

2.5

3.2

3.0

(1.8

,3.

2)(2

.0,

4.3)

(2.4

,3.

6)

3.4

1.8

2.9

(1.9

,4.

9)(1

.1,

2.6)

(2.2

,3.

7)W

est

4.0

(2.4

,5.

5)2.

3(1

.2,

3.3)

2.0

(1.3

,2.

6)2.

9(1

.8,

4.1)

2.5

(1.6

,3.

3)

MSA M

SAN

on-M

SA4.

45.

5(3

.8,

5.1)

(4.1

,6.

9)2.

93.

3(2

.3,

3.4)

(1.9

,4.

7)2.

72.

8(2

.2,

3.2)

(2.0

,3.

6)2.

93.

0(2

.4,

3.4)

(1.6

,4.

4)2.

43.

7(1

.9,

2.9)

(2.5

,4.

9)

Pove

rty

stat

us

,20

0%of

pove

rty

line

$20

0%of

pove

rty

line

5.0

4.5

(4.2

,5.

9)(3

.7,

5.3)

3.9

2.2

(3.0

,4.

8)(1

.6,

2.8)

3.3

2.3

(2.7

,4.

0)(1

.8,

2.8)

3.4

2.7

(2.5

,4.

2)(2

.0,

3.3)

3.6

2.0

(2.8

,4.

5)(1

.4,

2.5)

*Sou

rce:

1987

Nat

iona

lM

edic

alE

xpen

ditu

reSu

rvey

(NM

ES)

;19

96–1

999

Med

ical

Exp

endi

ture

Pane

lSu

rvey

(ME

PS).

Age

ncy

for

Hea

lthca

reR

esea

rch

and

Qua

lity.

CI

indi

cate

sco

nfide

nce

inte

rval

;M

SA,

met

ropo

litan

stat

istic

alar

ea.

Tab

leA

-4.

Em

erge

ncy

Dep

artm

ent

Use

for

Chi

ldre

n17

Yea

rsof

Age

and

You

nger

byY

ear*

Cha

ract

eris

tic

1987

Perc

ent

With

Any

Vis

its95

%C

I

1996

Perc

ent

With

Any

Vis

its95

%C

I

1997

Perc

ent

With

Any

Vis

its95

%C

I

1998

Perc

ent

With

Any

Vis

its95

%C

I

1999

Perc

ent

With

Any

Vis

its95

%C

I

Tota

l17

.1(1

6.0,

18.2

)12

.9(1

1.9,

14.0

)11

.9(1

1.1,

12.8

)11

.8(1

0.9,

12.8

)11

.1(1

0.3,

12.0

)

Hea

lthin

sura

nce

cove

rage

Any

priv

ate

Publ

icon

lyU

nins

ured

16.8

21.9

12.6

(15.

6,18

.0)

(18.

8,25

.1)

(10.

0,15

.2)

12.5

15.5

10.8

(11.

3,13

.7)

(13.

1,17

.9)

(8.2

,13

.4)

11.6

14.2 9.7

(10.

6,12

.6)

(12.

4,16

.0)

(7.4

,12

.0)

11.4

14.7 9.0

(10.

1,12

.6)

(12.

6,16

.8)

(6.3

,11

.7)

11.1

12.7 7.8

(10.

0,12

.2)

(10.

7,14

.6)

(5.2

,10

.3)

Age

0–

4y

5–9

y10

–14

y15

–17

y

22.2

16.0

12.5

17.4

(20.

1,24

.2)

(14.

2,17

.8)

(11.

0,13

.9)

(15.

3,19

.6)

15.9

11.2

11.7

13.1

(13.

9,17

.8)

(9.3

,13

.0)

(9.8

,13

.5)

(10.

6,15

.7)

16.1

10.3 9.3

12.4

(14.

2,18

.1)

(8.9

,11

.7)

(7.9

,10

.6)

(10.

4,14

.5)

16.8

10.5 8.9

11.1

(14.

8,18

.8)

(8.8

,12

.2)

(7.2

,10

.6)

(8.8

,13

.3)

15.0 9.0

8.8

12.6

(13.

0,17

.0)

(7.5

,10

.5)

(7.2

,10

.4)

(10.

2,15

.0)

Sex M

ale

Fem

ale

19.3

14.9

(17.

8,20

.7)

(13.

5,16

.3)

13.8

12.1

(12.

4,15

.1)

(10.

7,13

.4)

12.5

11.4

(11.

3,13

.7)

(10.

1,12

.6)

12.5

11.1

(11.

1,13

.9)

(9.9

,12

.4)

12.7 9.5

(11.

4,14

.0)

(8.3

,10

.7)

Rac

e/E

thni

city

Whi

te,

non-

His

pani

cA

fric

anA

mer

ican

,no

n-H

ispa

nic

His

pani

cO

ther

,no

n-H

ispa

nic

17.7

18.5

12.6

14.6

(16.

3,19

.0)

(16.

6,20

.4)

(9.5

,15

.7)

(10.

4,18

.7)

14.4

10.3

11.1 7.2

(13.

0,15

.8)

(8.1

,12

.6)

(9.5

,12

.8)

(3.8

,10

.5)

12.2

12.1

11.7 8.4

(11.

0,13

.4)

(10.

2,13

.9)

(10.

2,13

.2)

(4.6

,12

.1)

12.4

13.3 9.9

4.7

(11.

1,13

.7)

(10.

9,15

.7)

(8.1

,11

.7)

(1.4

,8.

0)

11.4

11.3

10.4 8.9

(10.

3,12

.5)

(8.9

,13

.8)

(8.6

,12

.2)

(4.5

,13

.4)

Perc

eive

dhe

alth

stat

us

Exc

elle

nt,

very

good

,go

odFa

iror

poor

16.6

31.6

(15.

4,17

.8)

(26.

8,36

.5)

12.8

22.7

(11.

7,13

.8)

(15.

7,29

.7)

11.5

30.3

(10.

6,12

.4)

(23.

7,36

.8)

11.7

21.3

(10.

7,12

.7)

(14.

7,27

.8)

10.9

25.7

(10.

0,11

.8)

(16.

8,34

.5)

Reg

ion

Nor

thea

stM

idw

est

Sout

hW

est

19.8

17.9

16.2

15.2

(17.

8,21

.8)

(15.

7,20

.2)

(14.

2,18

.3)

(13.

3,17

.1)

14.2

16.2

12.6 9.3

(11.

8,16

.7)

(13.

6,18

.7)

(10.

8,14

.4)

(7.7

,10

.8)

9.9

13.6

13.8 9.3

(7.9

,11

.9)

(11.

6,15

.5)

(12.

2,15

.3)

(7.8

,10

.8)

11.1

13.4

13.4 8.7

(9.2

,13

.1)

(11.

1,15

.6)

(11.

6,15

.1)

(7.1

,10

.2)

11.1

13.5

11.7 8.0

(8.7

,13

.5)

(11.

4,15

.6)

(10.

2,13

.3)

(6.8

,9.

2)

MSA M

SAN

on-M

SA16

.818

.1(1

5.7,

17.9

)(1

5.3,

20.8

)12

.415

.3(1

1.2,

13.5

)(1

2.8,

17.7

)11

.414

.4(1

0.4,

12.3

)(1

2.3,

16.6

)11

.214

.9(1

0.1,

12.2

)(1

2.4,

17.3

)10

.812

.8(9

.8,

11.7

)(1

0.8,

14.9

)

Pove

rty

stat

us

,20

0%of

pove

rty

line

$20

0%of

pove

rty

line

19.3

15.6

(17.

5,21

.0)

(14.

4,16

.8)

13.7

12.4

(12.

2,15

.2)

(11.

0,13

.7)

13.8

10.6

(12.

5,15

.0)

(9.5

,11

.8)

13.3

10.9

(11.

8,14

.8)

(9.4

,12

.3)

12.7

10.1

(11.

3,14

.2)

(9.0

,11

.2)

*Sou

rce:

1987

Nat

iona

lM

edic

alE

xpen

ditu

reSu

rvey

(NM

ES)

;19

96–1

999

Med

ical

Exp

endi

ture

Pane

lSu

rvey

(ME

PS).

Age

ncy

for

Hea

lthca

reR

esea

rch

and

Qua

lity.

CI

indi

cate

sco

nfide

nce

inte

rval

;M

SA,

met

ropo

litan

stat

istic

alar

ea.

Tab

leA

-5.

Den

tal

Use

for

Chi

ldre

n17

Yea

rsof

Age

and

You

nger

byY

ear*

Cha

ract

eris

tic

1987

Perc

ent

With

Any

Vis

its95

%C

I

1996

Perc

ent

With

Any

Vis

its95

%C

I

1997

Perc

ent

With

Any

Vis

its95

%C

I

1998

Perc

ent

With

Any

Vis

its95

%C

I

1999

Perc

ent

With

Any

Vis

its95

%C

I

Tota

l40

.1(3

8.3,

41.9

)42

.5(4

0.5,

44.5

)41

.3(3

9.5,

43.2

)42

.1(4

0.1,

44.1

)42

.1(4

0.2,

44.1

)

Hea

lthin

sura

nce

cove

rage

Any

priv

ate

Publ

icon

lyU

nins

ured

45.9

25.7

18.7

(43.

9,47

.9)

(22.

5,28

.8)

(15.

7,21

.8)

50.1

28.6

20.7

(47.

6,52

.6)

(25.

2,32

.0)

(16.

3,25

.1)

48.2

28.5

22.0

(46.

1,50

.4)

(25.

9,31

.2)

(18.

4,25

.5)

49.8

27.3

20.4

(47.

4,52

.3)

(24.

0,30

.6)

(16.

2,24

.5)

48.8

27.5

19.5

(46.

5,51

.1)

(24.

2,30

.8)

(15.

0,23

.9)

Age

0–

4y

5–9

y10

–14

y15

–17

y

13.7

51.8

51.8

47.7

(12.

1,15

.2)

(48.

6,55

.0)

(49.

0,54

.7)

(44.

8,50

.6)

15.6

53.2

54.3

50.0

(13.

6,17

.6)

(49.

8,56

.6)

(51.

1,57

.5)

(46.

0,53

.9)

13.4

50.5

53.4

51.2

(11.

5,15

.2)

(47.

5,53

.5)

(50.

5,56

.3)

(48.

0,54

.5)

16.6

50.8

53.0

49.9

(14.

5,18

.7)

(47.

3,54

.3)

(49.

5,56

.5)

(46.

1,53

.7)

13.7

52.4

55.6

48.2

(11.

8,15

.6)

(49.

1,55

.8)

(52.

4,58

.8)

(44.

3,52

.0)

Sex M

ale

Fem

ale

39.2

41.0

(37.

2,41

.1)

(38.

7,43

.4)

41.6

43.5

(30.

0,44

.1)

(41.

1,45

.9)

39.4

43.3

(37.

2,41

.7)

(41.

1,45

.5)

41.1

43.1

(38.

6,43

.6)

(40.

5,45

.7)

41.0

43.3

(38.

7,43

.3)

(41.

0,45

.7)

Rac

e/E

thni

city

Whi

te,

non-

His

pani

cA

fric

anA

mer

ican

,no

n-H

ispa

nic

His

pani

cO

ther

,no

n-H

ispa

nic

46.3

24.7

23.7

33.5

(44.

1,48

.6)

(22.

0,27

.4)

(20.

4,26

.9)

(24.

7,42

.3)

49.3

27.2

29.2

42.2

(46.

5,52

.0)

(23.

3,31

.1)

(26.

3,32

.0)

(33.

0,51

.3)

47.7

28.0

27.7

43.6

(45.

4,50

.1)

(24.

9,31

.1)

(25.

1,30

.4)

(36.

2,50

.9)

49.4

28.9

25.9

41.7

(46.

7,52

.0)

(24.

7,33

.0)

(23.

2,28

.6)

(32.

6,50

.8)

49.7

29.6

24.3

40.9

(47.

1,52

.3)

(24.

8,34

.5)

(21.

7,27

.0)

(30.

5,51

.2)

Perc

eive

dhe

alth

stat

us

Exc

elle

nt,

very

good

,go

odFa

iror

poor

44.3

34.6

(42.

2,46

.3)

(28.

9,40

.3)

43.3

36.3

(41.

2,45

.3)

(28.

4,44

.1)

42.1

32.9

(40.

3,44

.0)

(26.

2,39

.6)

42.7

30.2

(40.

7,44

.8)

(22.

0,38

.3)

42.9

30.6

(41.

0,44

.9)

(22.

5,38

.8)

Reg

ion

Nor

thea

stM

idw

est

Sout

hW

est

46.6

44.9

34.1

38.7

(41.

7,51

.6)

(42.

1,47

.7)

(31.

4,36

.7)

(33.

9,43

.5)

43.9

52.6

36.0

40.8

(39.

1,48

.8)

(48.

6,56

.6)

(32.

7,39

.2)

(36.

8,44

.8)

45.3

47.3

36.3

39.7

(40.

6,50

.0)

(43.

8,50

.8)

(33.

5,39

.2)

(36.

0,43

.4)

45.4

48.0

36.1

42.1

(40.

3,50

.5)

(43.

5,52

.4)

(33.

2,39

.0)

(37.

8,46

.3)

48.3

46.6

36.9

40.4

(43.

6,52

.9)

(42.

7,50

.6)

(33.

7,40

.0)

(36.

6,44

.1)

MSA M

SAN

on-M

SA40

.738

.3(3

8.6,

42.9

)(3

5.0,

41.7

)42

.741

.8(4

0.4,

45.0

)(3

7.9,

45.7

)42

.039

.1(3

9.9,

44.0

)(3

5.8,

42.4

)42

.839

.2(4

0.6,

45.0

)(3

4.0,

44.4

)41

.943

.2(3

9.8,

44.0

)(3

8.3,

48.2

)

Pove

rty

stat

us

,20

0%of

pove

rty

line

$20

0%of

pove

rty

line

26.8

49.6

(24.

5,29

.0)

(47.

3,51

.8)

28.1

53.6

(25.

7,30

.5)

(51.

0,56

.1)

28.9

50.2

(26.

6,31

.2)

(47.

7,52

.6)

26.9

52.2

(24.

5,29

.2)

(49.

6,54

.9)

26.9

52.2

(24.

8,29

.0)

(49.

5,54

.9)

*Sou

rce:

1987

Nat

iona

lM

edic

alE

xpen

ditu

reSu

rvey

(NM

ES)

;19

96–1

999

Med

ical

Exp

endi

ture

Pane

lSu

rvey

(ME

PS).

Age

ncy

for

Hea

lthca

reR

esea

rch

and

Qua

lity.

CI

indi

cate

sco

nfide

nce

inte

rval

;M

SA,

met

ropo

litan

stat

istic

alar

ea.

Tab

leA

-6.

Pres

crip

tion

(Scr

ipts

)M

edic

ine

Use

for

Chi

ldre

n17

Yea

rsof

Age

and

You

nger

byY

ear*

Cha

ract

eris

tic

1987

Perc

ent

With

Any

Scri

pts

95%

CI

1996

Perc

ent

With

Any

Scri

pts

95%

CI

1997

Perc

ent

With

Any

Scri

pts

95%

CI

1998

Perc

ent

With

Any

Scri

pts

95%

CI

1999

Perc

ent

With

Any

Scri

pts

95%

CI

Tota

l50

.9(4

9.3,

52.5

)55

.6(5

4.1,

57.1

)52

.5(5

1.1,

54.0

)50

.5(4

8.9,

52.1

)50

.3(4

8.5,

52.0

)

Hea

lthin

sura

nce

cove

rage

Any

priv

ate

Publ

icon

lyU

nins

ured

54.2

45.6

34.5

(52.

6,55

.8)

(41.

9,49

.4)

(30.

4,38

.6)

59.1

52.9

38.4

(57.

1,61

.0)

(49.

7,56

.1)

(34.

0,42

.8)

54.8

52.2

38.7

(52.

9,56

.6)

(49.

3,55

.1)

(34.

6,42

.7)

53.2

49.8

33.2

(51.

2,55

.2)

(46.

8,52

.9)

(29.

0,37

.3)

52.8

49.5

29.8

(50.

8,54

.8)

(46.

1,52

.9)

(25.

5,34

.1)

Age

0–

4y

5–9

y10

–14

y15

–17

y

63.1

51.7

40.4

44.8

(60.

9,65

.4)

(49.

3,54

.1)

(37.

8,43

.1)

(42.

2,47

.4)

65.7

58.8

46.0

49.3

(62.

8,68

.7)

(56.

2,61

.4)

(43.

1,48

.8)

(45.

5,53

.2)

62.5

53.0

45.9

46.2

(59.

9,65

.2)

(50.

6,55

.4)

(43.

2,48

.5)

(43.

0,49

.3)

59.4

50.5

44.4

46.5

(56.

4,62

.3)

(47.

6,53

.5)

(41.

7,47

.0)

(42.

8,50

.2)

59.6

49.9

44.3

45.5

(56.

6,62

.7)

(46.

9,53

.0)

(41.

4,47

.2)

(42.

1,48

.9)

Sex M

ale

Fem

ale

50.1

51.8

(48.

2,51

.9)

(49.

8,53

.7)

55.8

55.4

(53.

7,57

.9)

(53.

3,57

.4)

52.5

52.6

(50.

4,54

.5)

(50.

6,54

.5)

50.0

51.0

(47.

8,52

.3)

(48.

9,53

.2)

50.6

49.9

(48.

4,52

.8)

(47.

6,52

.2)

Rac

e/E

thni

city

Whi

te,

non-

His

pani

cA

fric

anA

mer

ican

,no

n-H

ispa

nic

His

pani

cO

ther

,no

n-H

ispa

nic

57.0

34.9

39.1

37.5

(55.

3,58

.6)

(31.

7,38

.1)

(35.

2,43

.0)

(29.

8,45

.2)

60.5

43.9

49.4

45.2

(58.

5,62

.6)

(39.

9,47

.8)

(45.

7,53

.0)

(38.

6,51

.8)

57.0

42.0

47.8

41.4

(55.

1,58

.9)

(38.

9,45

.2)

(45.

4,50

.2)

(34.

6,48

.1)

56.2

37.4

44.4

35.5

(54.

3,58

.0)

(33.

4,41

.4)

(41.

7,47

.1)

(26.

2,44

.8)

55.7

38.7

42.0

41.3

(53.

3,58

.1)

(34.

6,42

.9)

(39.

2,44

.7)

(33.

7,48

.9)

Perc

eive

dhe

alth

stat

us

Exc

elle

nt,

very

good

,go

odFa

iror

poor

50.6

65.8

(49.

0,52

.3)

(60.

7,70

.8)

55.6

76.1

(54.

1,57

.2)

(69.

0,83

.3)

52.1

82.9

(50.

6,53

.6)

(78.

3,87

.6)

50.0

80.5

(48.

4,51

.6)

(71.

9,89

.1)

49.9

85.2

(48.

1,51

.7)

(78.

6,91

.7)

Reg

ion

Nor

thw

est

Mid

wes

tSo

uth

Wes

t

53.9

54.4

46.8

51.0

(50.

6,57

.2)

(51.

8,57

.0)

(43.

8,49

.8)

(48.

4,53

.7)

58.3

59.4

54.2

51.7

(54.

6,61

.9)

(56.

3,62

.4)

(51.

7,56

.8)

(48.

7,54

.8)

47.4

54.6

54.4

51.6

(43.

9,50

.9)

(51.

5,57

.6)

(51.

8,57

.0)

(48.

8,54

.5)

47.8

53.1

50.7

49.7

(44.

2,51

.4)

(49.

8,56

.5)

(47.

9,53

.5)

(46.

3,53

.0)

54.6

53.0

49.2

45.9

(50.

5,58

.7)

(48.

9,57

.1)

(46.

2,52

.1)

(43.

1,48

.8)

MSA M

SAN

on-M

SA50

.651

.8(4

8.8,

52.3

)(4

8.3,

55.3

)55

.556

.4(5

3.8,

57.1

)(5

2.6,

60.2

)51

.756

.2(5

0.1,

53.4

)(5

3.1,

59.3

)49

.654

.6(4

7.8,

51.5

)(5

1.9,

57.4

)49

.852

.5(4

7.8,

51.8

)(4

8.8,

56.1

)

Pove

rty

stat

us

,20

0%of

pove

rty

line

$20

0%of

pove

rty

line

43.0

56.5

(40.

9,45

.2)

(54.

9,58

.1)

50.2

59.7

(47.

9,52

.5)

(57.

6,61

.8)

47.3

56.2

(45.

3,49

.4)

(54.

2,58

.2)

45.0

54.2

(42.

6,47

.4)

(52.

0,56

.4)

47.3

52.2

(44.

8,49

.8)

(50.

0,54

.5)

*Sou

rce:

1987

Nat

iona

lM

edic

alE

xpen

ditu

reSu

rvey

(NM

ES)

;19

96–1

999

Med

ical

Exp

endi

ture

Pane

lSu

rvey

(ME

PS).

Age

ncy

for

Hea

lthca

reR

esea

rch

and

Qua

lity.

CI

indi

cate

sco

nfide

nce

inte

rval

;M

SA,

met

ropo

litan

stat

istic

alar

ea.

Tab

leA

-7.

Perc

ent

ofTo

tal

Exp

endi

ture

sA

ttrib

utab

leto

Chi

ldre

n17

Yea

rsof

Age

and

You

nger

byY

ear*

Cha

ract

eris

tic

1987

Perc

ent

Attr

ibut

able

95%

CI

1996

Perc

ent

Attr

ibut

able

95%

CI

1997

Perc

ent

Attr

ibut

able

95%

CI

1998

Perc

ent

Attr

ibut

able

95%

CI

1999

Perc

ent

Attr

ibut

able

95%

CI

Tota

l13

.6(1

1.2,

15.9

)11

.2(9

.4,

12.9

)10

.1(8

.8,

11.4

)9.

6(8

.4,

10.8

)10

.3(9

.1,

11.5

)

Hea

lthin

sura

nce

cove

rage

Any

priv

ate

Publ

icon

lyU

nins

ured

14.0

11.0

15.8

(11.

2,16

.8)

(8.7

,13

.3)

(11.

4,20

.1)

11.4

10.7 9.6

(9.3

,13

.4)

(7.3

,14

.0)

(6.5

,12

.7)

10.8 7.1

13.4

(9.1

,12

.5)

(5.8

,8.

4)(7

.4,

19.4

)

11.1 5.8

9.1

(9.4

,12

.8)

(4.5

,7.

1)(5

.6,

12.5

)

11.4 7.1

13.3

(9.9

,12

.8)

(5.0

,9.

3)(4

.0,

22.5

)

Age

0–

4y

5–9

y10

–14

y15

–17

y

Sex M

ale

Fem

ale

16.2

11.6

(11.

7,20

.7)

(10.

0,13

.2)

13.1 9.6

(10.

1,16

.0)

(7.5

,11

.7)

11.6 8.9

(9.7

,13

.4)

(7.1

,10

.7)

12.0 8.0

(10.

2,13

.7)

(6.3

,9.

6)12

.5 8.7

(10.

5,14

.6)

(7.2

,10

.3)

Rac

e/E

thni

city

Whi

te,

non-

His

pani

cA

fric

anA

mer

ican

,no

n-H

ispa

nic

His

pani

cO

ther

,no

n-H

ispa

nic

13.7

10.8

17.9

16.0

(10.

9,16

.4)

(8.5

,13

.2)

(13.

6,22

.3)

(11.

2,20

.9)

10.0

15.4

17.9

14.1

(8.2

,11

.8)

(8.5

,22

.4)

(9.4

,26

.4)

(8.2

,19

.9)

9.0

12.0

19.0

13.6

(7.6

,10

.3)

(7.9

,16

.1)

(11.

6,26

.3)

(7.8

,19

.4)

8.8

10.1

17.4 7.9

(7.4

,10

.2)

(7.6

,12

.6)

(12.

9,22

.0)

(3.7

,12

.1)

10.0 7.4

17.2

10.5

(8.5

,11

.5)

(5.5

,9.

3)(1

3.2,

21.2

)(4

.6,

16.3

)

Perc

eive

dhe

alth

stat

us

Exc

elle

nt,

very

good

,go

odFa

iror

poor

15.8 4.4

(14.

1,17

.4)

(2.6

,6.

3)15

.5 4.1

(13.

4,17

.5)

(1.4

,6.

9)14

.1 3.4

(12.

6,15

.6)

(1.7

,5.

0)13

.5 2.2

(12.

2,14

.7)

(1.3

,3.

1)14

.1 3.4

(12.

5,15

.6)

(1.7

,5.

1)

Reg

ion

Nor

thea

stM

idw

est

Sout

h

12.4

16.2

13.4

(10.

3,14

.4)

(12.

7,19

.7)

(7.4

,19

.3)

11.3

12.0 9.6

(7.9

,14

.8)

(7.9

,16

.1)

(7.4

,11

.8)

8.9

10.6 8.8

(7.4

,10

.4)

(8.5

,12

.6)

(6.9

,10

.6)

7.9

11.8 8.1

(6.3

,9.

4)(8

.3,

15.4

)(6

.6,

9.7)

11.8

10.3 8.9

(8.6

,15

.0)

(7.8

,12

.7)

(6.9

,10

.8)

Wes

t12

.0(9

.0,

15.0

)12

.4(8

.1,

16.6

)12

.8(8

.6,

17.1

)11

.3(9

.0,

13.5

)11

.2(8

.7,

13.8

)

MSA

*

MSA

Non

-MSA

12.4

17.9

(10.

9,13

.8)

(9.1

,26

.7)

12.4 9.9

(10.

3,14

.6)

(7.1

,12

.8)

11.5 7.7

(10.

0,13

.0)

(6.1

,9.

2)10

.8 8.5

(9.3

,12

.2)

(6.4

,10

.7)

10.9

10.8

(9.5

,12

.3)

(7.4

,14

.2)

Pove

rty

stat

us

,20

0%of

pove

rty

line

$20

0%of

pove

rty

line

14.8

12.9

(9.0

,20

.6)

(11.

2,14

.7)

10.3

11.7

(7.8

,12

.7)

(9.4

,14

.0)

9.6

10.3

(7.7

,11

.5)

(8.6

,12

.1)

9.5

9.6

(6.9

,12

.2)

(8.5

,10

.7)

11.5 9.7

(8.9

,14

.1)

(8.5

,11

.0)

*Sou

rce:

1987

Nat

iona

lM

edic

alE

xpen

ditu

reSu

rvey

(NM

ES)

;19

96–1

999

Med

ical

Exp

endi

ture

Pane

lSu

rvey

(ME

PS).

Age

ncy

for

Hea

lthca

reR

esea

rch

and

Qua

lity.

CI

indi

cate

sco

nfide

nce

inte

rval

;M

SA,

met

ropo

litan

stat

istic

alar

ea.

Tab

leA

-8.

Mea

nE

xpen

ditu

res

per

Chi

ld(1

7Y

ears

ofA

gean

dY

oung

er)

With

Exp

endi

ture

sfo

rE

ach

Typ

eof

Hea

lthC

are

Serv

ice

byY

ear*

Yea

r

Offi

ce-B

ased

Mea

n95

%C

I

Hos

pita

lO

utpa

tient

Mea

n95

%C

I

Hos

pita

lIn

patie

nt

Mea

n95

%C

I

Em

erge

ncy

Dep

artm

ent

Mea

n95

%C

I

Den

tal

Mea

n95

%C

I

Pres

crip

tion

Med

icat

ion

Mea

n95

%C

I

1987

1996

1997

1998

1999

$228

$272

$291

$290

$295

($21

5,$2

42)

($25

2,$2

92)

($24

2,$3

40)

($25

9,$3

21)

($26

9,$3

22)

$840

$926

$108

7$1

086

$123

0

($74

6,$9

34)

($71

7,$1

135)

($88

7,$1

287)

($90

6,$1

266)

($93

7,$1

523)

$782

2$1

137

9$8

547

$605

3$7

590

($44

63,

$11

181)

($77

11,

$15

048)

($55

59,

$11

536)

($38

05,

$830

1)($

4943

,$1

023

8)

$277

$530

$448

$395

$520

($25

9,$2

96)

($33

9,$7

21)

($39

4,$5

02)

($36

2,$4

28)

($41

2,$6

28)

$451

$408

$407

$430

$467

($41

3,$4

89)

($35

6,$4

61)

($36

9,$4

45)

($37

3,$4

88)

($40

1,$5

33)

$93

$113

$125

$123

$153

($60

,$1

26)

($92

,$1

33)

($11

1,$1

38)

($11

3,$1

34)

($12

0,$1

87)

*Sou

rce:

1987

Nat

iona

lM

edic

alE

xpen

ditu

reSu

rvey

(NM

ES)

;19

96–1

999

Med

ical

Exp

endi

ture

Pane

lSu

rvey

(ME

PS).

Age

ncy

for

Hea

lthca

reR

esea

rch

and

Qua

lity.

CI

indi

cate

sco

nfide

nce

inte

rval

.E

xpen

ditu

res

are

Con

sum

erPr

ice

Inde

x(C

PI)-

adju

sted

to19

99do

llars

.

Table A-9. Percent Distribution of Source of Payment for Total Health Care Expenditures for Children 17 Years of Age and Younger byYear*

Year

Total DollarExpenditures(in Millions) 95% CI

Percent Distribution of Source of Payment forChildren With Any Expenditures (95% CI)

Private Medicaid Out of Pocket Other

1996199719981999

$64 932$57 956$54 839$61 478

($54 373, $75 490)($50 230, $65 681)($48 125, $61 544)($53 382, $69 754)

55.1 (48.2, 62.1)54.3 (48.8, 59.8)56.4 (51.0, 61.9)50.9 (45.9, 55.9)

19.5 (13.2, 25.7)13.9 (11.3, 16.5)16.0 (12.3, 19.8)17.1 (12.5, 21.6)

20.2 (16.9, 23.5)24.2 (20.6, 27.9)22.4 (19.7, 25.1)22.7 (19.9, 25.4)

5.2 (1.9, 8.6)7.6 (4.8, 10.3)5.1 (3.5, 6.7)9.4 (5.7, 13.0)

*Source: 1996–1999 Medical Expenditure Panel Survey (MEPS). Agency for Healthcare Research and Quality. CI indicates confidenceinterval. Totals are total dollar expenditures for all health care services. Expenditures are Consumer Price Index (CPI)-adjusted to 1999dollars.

Tab

leA

-10.

Hea

lthC

are

Qua

lity

for

Chi

ldre

n17

Yea

rsof

Age

and

Und

er,

2000

–01†

Perc

enta

geof

Chi

ldre

n(9

5%C

I)

2000

Tota

lA

nyPr

ivat

eIn

sura

nce

Publ

ic-O

nly

Insu

ranc

eU

nins

ured

2001

Tota

lA

nyPr

ivat

eIn

sura

nce

Publ

ic-O

nly

Insu

ranc

eU

nins

ured

Perc

ent

ofch

ildre

nw

how

ent

todo

ctor

’sof

fice

orcl

inic

duri

ngth

ela

st12

mo

(exc

ludi

ngem

erge

ncy

room

).O

fth

ose:

78.0

(76.

2,79

.9)

82.4

(80.

6,84

.3)

77.7

(74.

0,81

.4)

57.6

(53.

0,62

.3)

75.8

(74.

2,77

.3)

79.5

(77.

9,81

.2)

77.0

(74,

80)

57.5

(53.

5,61

.5)

Perc

ent

dist

ribu

tion

byex

tent

ofpr

oble

min

rece

ivin

gne

cess

ary

care

Abi

gpr

oble

mA

smal

lpr

oble

mN

ota

prob

lem

1.9

(1.3

,2.

5)9.

5(8

.2,

10.8

)88

.6(8

7.2,

89.9

)

1.0

(0.6

,1.

3)7.

0(5

.7,

8.2)

92.1

(90.

8,93

.4)

3.8

(1.7

,6.

0)16

.5(1

3.1,

19.9

)79

.6(7

5.4,

83.9

)

4.1

(1.9

,6.

2)11

.7(8

.2,

15.2

)84

.2(7

9.7,

88.7

)

1.5

(1.1

,1.

9)6.

6(5

.8,

7.4)

91.9

(90.

9,92

.8)

1.2

(0.8

,1.

6)5.

7(4

.7,

6.6)

93.2

(92,

94.3

)

2.6

(1.7

,3.

4)7.

9(6

.4,

9.5)

89.5

(87.

7,91

.2)

1.4*

(0.5

,2.

3)9.

5(7

.2,

11.8

)89

.1(8

6.6,

91.6

)

Perc

ent

ofch

ildre

nw

hose

pare

ntor

ado

ctor

thou

ght

the

child

need

edto

see

asp

ecia

list.

Of

thos

e:18

.1(1

6.6,

19.5

)20

.5(1

8.6,

22.4

)15

.5(1

3.7,

17.4

)10

.4(7

.4,

13.4

)17

.4(1

6.3,

18.4

)19

.7(1

8.3,

21)

16.5

(14.

5,18

.5)

9.0

(7.2

,10

.8)

Perc

ent

dist

ribu

tion

byex

tent

ofpr

oble

min

getti

nga

refe

rral

toa

spec

ialis

tA

big

prob

lem

Asm

all

prob

lem

Not

apr

oble

m

5.4

(3.4

,7.

4)17

.1(1

3.9,

20.4

)77

.5(7

4.2,

80.8

)

3.9

(2.1

,5.

7)14

.9(1

1.6,

18.2

)81

.2(7

7.5,

84.9

)

8.7*

(3.2

,14

.3)

24.7

(16.

8,32

.5)

66.6

(59.

4,73

.8)

...

...

...

...

...

...

7.2

(5.5

,8.

8)9.

5(7

.6,

11.5

)83

.3(8

0.7,

86)

5.3

(3.4

,7.

2)9.

1(7

,11

.2)

85.5

(82.

5,88

.5)

13.2

(8.7

,17

.7)

12.1

(6.8

,17

.7)

74.7

(68.

4,81

)

7.1*

(2.6

,11

.7)

5.9*

(2.1

,9.

6)87

.0(8

1.1,

92.9

)

Perc

ent

ofch

ildre

nw

how

ent

toa

doct

or’s

offic

eor

clin

icdu

ring

the

last

12m

o(e

xclu

ding

emer

genc

yro

om).

Of

thos

e:78

.0(7

6.2,

79.9

)82

.4(8

0.6,

84.3

)77

.7(7

4.0,

81.4

)57

.6(5

3.0,

62.3

)75

.8(7

4.2,

77.3

)79

.5(7

7.9,

81.2

)77

.0(7

4.0,

80.0

)57

.5(5

3.5,

61.5

)

Perc

ent

dist

ribu

tion

ofho

wof

ten

heal

thpr

ovid

ers

liste

ned

care

fully

topa

rent

sN

ever

/Som

etim

esU

sual

lyA

lway

s

6.5

(5.4

,7.

6)28

.1(2

5.9,

30.2

)65

.5(6

3.2,

67.8

)

4.4

(3.3

,5.

5)28

.4(2

5.9,

31.0

)67

.2(6

4.7,

69.7

)

12.4

(9.2

,15

.7)

23.7

(20.

0,27

.4)

63.9

(59.

4,68

.4)

7.6

(4.8

,10

.3)

35.3

(29.

5,41

.2)

57.1

(50.

8,63

.4)

7.0

(6.1

,8)

21.8

(20.

1,23

.5)

71.1

(69.

3,73

)

5.1

(4.2

,6.

1)22

.3(2

0.4,

24.3

)72

.5(7

0.4,

74.7

)

11.1

(8.8

,13

.3)

21.6

(18.

2,24

.9)

67.4

(63.

7,71

.1)

10.1

(7.5

,12

.7)

19.4

(15.

9,23

)70

.5(6

6.4,

74.6

)

Perc

ent

dist

ribu

tion

ofho

wof

ten

heal

thpr

ovid

ers

expl

aine

dth

ings

clea

rly

topa

rent

sN

ever

/Som

etim

esU

sual

lyA

lway

s

5.7

(4.9

,6.

5)25

.9(2

3.7,

28.0

)68

.4(6

6.1,

70.8

)

3.4

(2.7

,4.

0)25

.7(2

3.1,

28.2

)70

.9(6

8.3,

73.6

)

11.9

(8.8

,15

.0)

24.4

(20.

3,28

.6)

63.7

(58.

9,68

.4)

8.0

(5.1

,11

.0)

30.4

(24.

1,36

.6)

61.6

(55.

3,67

.9)

5.8

(4.9

,6.

7)20

.0(1

8.1,

21.9

)74

.2(7

2.1,

76.3

)

3.8

(3.1

,4.

6)20

.6(1

8.5,

22.7

)75

.6(7

3.3,

77.8

)

10.2

(7.9

,12

.4)

18.3

(15,

21.7

)71

.5(6

7.6,

75.4

)

8.5

(6,

11)

19.8

(16,

23.6

)71

.7(6

7.2,

76.2

)

Perc

ent

dist

ribu

tion

ofho

wof

ten

heal

thpr

ovid

ers

show

edre

spec

tfo

rw

hat

pare

ntsa

idN

ever

/Som

etim

esU

sual

lyA

lway

s

6.3

(5.3

,7.

4)26

.3(2

4.4,

28.3

)67

.3(6

5.0,

69.6

)

4.6

(3.6

,5.

6)26

.0(2

3.7,

28.4

)69

.3(6

6.8,

71.8

)

11.4

(8.3

,14

.6)

23.7

(19.

8,27

.5)

64.9

(60.

1,69

.7)

6.9

(4.2

,9.

5)34

.5(2

8.2,

40.8

)58

.7(5

2.5,

64.9

)

6.0

(5.1

,6.

9)20

.4(1

8.5,

22.3

)73

.6(7

1.6,

75.6

)

4.2

(3.4

,5)

21.5

(19.

3,23

.6)

74.3

(72,

76.6

)

9.8

(7.5

,12

.1)

17.9

(14.

3,21

.5)

72.3

(68.

4,76

.2)

8.7

(6.2

,11

.2)

19.4

(16,

22.9

)71

.9(6

7.8,

75.9

)

*Est

imat

esw

itha

rela

tive

stan

dard

erro

rgr

eate

rth

an30

%.

†Sou

rce:

2000

–200

1M

edic

alE

xpen

ditu

rePa

nel

Surv

ey(M

EPS

).A

genc

yfo

rH

ealth

care

Res

earc

han

dQ

ualit

y.C

Iin

dica

tes

confi

denc

ein

terv

al;

ellip

ses

are

used

whe

nsa

mpl

esi

zes

are

too

smal

lto

prov

ide

relia

ble

estim

ates

.

Tab

leA

-11.

Chi

ldre

n’s

Hea

lthIn

sura

nce

Cov

erag

e,20

01(F

irst

Hal

fof

Yea

r)*

Cha

ract

eris

tic

Num

ber

ofC

hild

ren

(in

thou

sand

s)

Perc

ent

With

Any

Priv

ate

Insu

ranc

e95

%C

I

Perc

ent

With

Publ

icIn

sura

nce

Onl

y95

%C

I

Perc

ent

Uni

nsur

edT

hrou

ghou

tth

eFi

rst

Hal

fof

the

Yea

r95

%C

I

Tota

l72

650

63.1

(61.

2,65

)22

.3(2

0.6,

24.1

)14

.6(1

3.4,

15.7

)

Age ,

1y

1–4

y5–

9y

10–1

4y

15–1

7y

3870

1596

720

117

2062

212

075

53.5

6.7

62.1

65.2

67.6

(48.

6,58

.4)

(57.

9,63

.5)

(59.

5,64

.7)

(62.

6,67

.7)

(64.

7,70

.5)

34.8

26.3

24.5

19.5

14.4

(30,

39.6

)(2

3.7,

28.8

)(2

2.1,

26.8

)(1

7.1,

22)

(12.

1,16

.7)

11.7

13.0

13.4

15.3

18.0

(8.6

,14

.9)

(11.

2,14

.8)

(11.

8,15

)(1

3.3,

17.3

)(1

5.7,

20.3

)

Sex M

ale

Fem

ale

3735

635

294

63.6

62.6

(61.

4,65

.9)

(60.

4,64

.7)

21.7

23.1

(19.

7,23

.6)

(21,

25.1

)14

.714

.4(1

3.3,

16.1

)(1

3,15

.7)

Rac

e/E

thni

city

Whi

te,

non-

His

pani

cA

fric

anA

mer

ican

,no

n-H

ispa

nic

His

pani

cO

ther

,no

n-H

ispa

nic

4522

511

207

1205

141

67

73.8

45.2

38.3

67.3

(71.

6,76

)(3

9.9,

50.6

)(3

4.6,

41.9

)(5

8.1,

76.5

)

14.6

43.3

32.8

20.3

(12.

8,16

.3)

(38.

1,48

.5)

(29.

6,35

.9)

(12.

1,28

.6)

11.7

11.5

29.0

12.4

(10.

2,13

.1)

(9.2

,13

.8)

(25.

8,32

.1)

(7.5

,17

.3)

Perc

eive

dhe

alth

stat

us

Exc

elle

nt,

very

good

,go

odFa

iror

poor

7031

923

0063

.647

.2(6

1.7,

65.5

)(4

0.3,

54.1

)21

.742

.3(1

9.9,

23.5

)(3

5.7,

48.9

)14

.710

.5(1

3.5,

15.9

)(6

.8,

14.1

)

Reg

ion

Nor

thea

stM

idw

est

Sout

hW

est

1332

717

210

2445

717

656

68.3

71.1

57.9

58.6

(64.

4,72

.2)

(67.

6,74

.7)

(54.

8,61

.1)

(54.

1,63

.2)

23.4

17.4

23.7

24.4

(19.

8,27

)(1

4.1,

20.7

)(2

0.5,

26.9

)(2

0.4,

28.5

)

8.4

11.5

18.4

17.0

(6.1

,10

.6)

(9.5

,13

.5)

(15.

9,20

.8)

(14.

9,19

)

MSA M

SAN

on-M

SA59

757

1289

363

.760

.6(6

1.6,

65.8

)(5

5.9,

65.3

)21

.426

.9(1

9.4,

23.3

)(2

2.3,

31.5

)15

.012

.6(1

3.6,

16.3

)(1

0.1,

15)

*Sou

rce:

2001

Med

ical

Exp

endi

ture

Pane

lSu

rvey

(ME

PS).

Age

ncy

for

Hea

lthca

reR

esea

rch

and

Qua

lity.

Chi

ldre

nar

ecl

assi

fied

asha

ving

priv

ate

insu

ranc

eif

they

wer

epr

ivat

ely

insu

red

(inc

ludi

ngco

vera

geth

roug

hth

eC

ivili

anH

ealth

and

Med

ical

Prog

ram

ofth

eU

nifo

rmed

Serv

ices

)at

any

time

duri

ngth

efir

stha

lfof

the

year

.C

hild

ren

with

nopr

ivat

eco

vera

gebu

tw

hoha

dco

vera

geth

roug

hM

edic

aid,

Med

icar

e,or

any

othe

rty

peof

gove

rnm

ent

prog

ram

prov

idin

gco

vera

gefo

rbo

thho

spita

lan

dm

edic

alca

rear

ecl

assi

fied

aspu

blic

lyin

sure

d.C

hild

ren

not

cove

red

byan

yco

mpr

ehen

sive

hosp

ital

and

phys

icia

nin

sura

nce

prog

ram

atan

ytim

edu

ring

the

first

half

ofth

eye

arar

ecl

assi

fied

asun

insu

red.

CI

indi

cate

sco

nfide

nce

inte

rval

;M

SA,

met

ropo

litan

stat

istic

alar

ea.

Tab

leA

-12.

Hea

lthC

are

Use

for

Chi

ldre

nA

ged

17Y

ears

and

Und

er,

1999

(Ful

l-Y

ear)

:Pe

rcen

tof

Chi

ldre

nW

ithV

isits

*

Cha

ract

eris

tic

Offi

ce-B

ased

Perc

ent

With

Any

Vis

its95

%C

I

Hos

pita

lO

utpa

tient

Perc

ent

With

Any

Vis

its95

%C

I

Hos

pita

lIn

patie

nt

Perc

ent

With

Any

Dis

char

ges

95%

CI

Em

erge

ncy

Dep

artm

ent

Perc

ent

With

Any

Vis

its95

%C

I

Den

tal

Perc

ent

With

Any

Vis

its95

%C

I

Pres

crip

tion

Med

icin

es

Perc

ent

With

Any

Scri

pts

95%

CI

Tota

l70

.1(6

8.3,

71.9

)6.

1(5

.4,

6.9)

2.6

(2.1

,3.

1)11

.1(1

0.3,

12)

42.1

(40.

2,44

.1)

50.3

(48.

5,52

)

Hea

lthin

sura

nce

cove

rage

Any

priv

ate

Publ

icon

lyU

nins

ured

73.6

68.6

43.0

(71.

5,75

.7)

(64.

9,72

.3)

(38.

2,47

.8)

6.6

5.8

3.1

(5.6

,7.

5)(4

.5,

7.1)

(1.5

,4.

6)

2.3

4.1

2.0

(1.8

,2.

8)(2

.9,

5.2)

(0.7

,3.

3)

11.1

12.7 7.8

(10,

12.2

)(1

0.7,

14.6

)(5

.2,

10.3

)

48.8

27.5

19.5

(46.

5,51

.1)

(24.

2,30

.8)

(15,

23.9

)

52.8

49.5

29.8

(50.

8,54

.8)

(46.

1,52

.9)

(25.

5,34

.1)

Age

0–

4y

5–9

y10

–14

y15

–17

y

82.4

66.6

65.7

63.3

(80.

1,84

.6)

(63.

5,69

.7)

(62.

8,68

.5)

(60,

66.7

)

5.8

6.1

6.7

5.8

(4.6

,7.

1)(4

.8,

7.3)

(5.3

,8.

1)(4

,7.

6)

5.2

1.6

1.2

2.7

(4.1

,6.

3)(0

.8,

2.3)

(0.7

,1.

8)(1

.2,

4.1)

15.0 9.0

8.8

12.6

(13,

17)

(7.5

,10

.5)

(7.2

,10

.4)

(10.

2,15

)

13.7

52.4

55.6

48.2

(11.

8,15

.6)

(49.

1,55

.8)

(52.

4,58

.8)

(44.

3,52

)

59.6

49.9

44.3

45.5

(56.

6,62

.7)

(46.

9,53

)(4

1.4,

47.2

)(4

2.1,

48.9

)

Sex M

ale

Fem

ale

70.4

69.8

(68.

3,72

.5)

(67.

4,72

.1)

6.3

6.0

(5.2

,7.

3)(5

,7)

3.2

2.0

(2.5

,4)

(1.4

,2.

6)12

.7 9.5

(11.

4,14

)(8

.3,

10.7

)41

.043

.3(3

8.7,

43.3

)(4

1,45

.7)

50.6

49.9

(48.

4,52

.8)

(47.

6,52

.2)

Rac

e/E

thni

city

Whi

te,

non-

His

pani

cA

fric

anA

mer

ican

,non

-His

pani

cH

ispa

nic

Oth

er,

non-

His

pani

c

76.1

57.0

60.1

65.3

(74.

1,78

.1)

(51.

9,62

.1)

(56.

8,63

.4)

(57.

4,73

.2)

7.2

4.5

4.4

2.9

(6.2

,8.

2)(2

.9,

6)(3

.1,

5.7)

(0.8

,4.

9)

2.6

2.2

2.9

4.1

(2,

3.2)

(1.2

,3.

1)(2

,3.

8)(1

,7.

2)

11.4

11.3

10.4 8.9

(10.

3,12

.5)

(8.9

,13

.8)

(8.6

,12

.2)

(4.5

,13

.4)

49.7

29.6

24.3

40.9

(47.

1,52

.3)

(24.

8,34

.5)

(21.

7,27

)(3

0.5,

51.2

)

55.7

38.7

42.0

41.3

(53.

3,58

.1)

(34.

6,42

.9)

(39.

2,44

.7)

(33.

7,48

.9)

Pove

rty

,20

0%of

pove

rty

line

$20

0%of

pove

rty

line

63.9

74.2

(61.

1,66

.7)

(72.

1,76

.3)

5.0

6.9

(4,

5.9)

(5.9

,7.

9)3.

62.

0(2

.8,

4.5)

(1.4

,2.

5)12

.710

.1(1

1.3,

14.2

)(9

,11

.2)

26.9

52.2

(24.

8,29

)(4

9.5,

54.9

)47

.352

.2(4

4.8,

49.8

)(5

0,54

.5)

Perc

eive

dhe

alth

stat

us

Exc

elle

nt,

very

good

,go

odFa

iror

poor

69.7

90.1

(67.

8,71

.5)

(85.

4,94

.8)

5.9

18.1

(5.1

,6.

6)(1

0.8,

25.3

)2.

214

.2(1

.7,

2.7)

(7.1

,21

.3)

10.9

25.7

(10,

11.8

)(1

6.8,

34.5

)42

.930

.6(4

1,44

.9)

(22.

5,38

.8)

49.9

85.2

(48.

1,51

.7)

(78.

6,91

.7)

Reg

ion

Nor

thea

st78

.5(7

5.2,

81.8

)8.

3(6

.3,

10.3

)3.

4(1

.9,

4.9)

11.1

(8.7

,13

.5)

48.3

(43.

6,52

.9)

54.6

(50.

5,58

.7)

Mid

wes

tSo

uth

Wes

t

71.9

66.2

67.5

(68.

1,75

.7)

(62.

8,69

.7)

(63.

7,71

.3)

7.2

5.5

4.4

(5.7

,8.

8)(4

.2,

6.7)

(3.1

,5.

7)

1.8

2.9

2.5

(1.1

,2.

6)(2

.2,

3.7)

(1.6

,3.

3)

13.5

11.7 8.0

(11.

4,15

.6)

(10.

2,13

.3)

(6.8

,9.

2)

46.6

36.9

40.4

(42.

7,50

.6)

(33.

7,40

)(3

6.6,

44.1

)

53.0

49.2

45.9

(48.

9,57

.1)

(46.

2,52

.1)

(43.

1,48

.8)

MSA M

SAN

on-M

SA70

.668

.2(6

8.5,

72.6

)(6

4.2,

72.1

)6.

16.

1(5

.3,

6.9)

(4.5

,7.

7)2.

43.

7(1

.9,

2.9)

(2.5

,4.

9)10

.812

.8(9

.8,

11.7

)(1

0.8,

14.9

)41

.943

.2(3

9.8,

44)

(38.

3,48

.2)

49.8

52.5

(47.

8,51

.8)

(48.

8,56

.1)

*Sou

rce:

1999

Med

ical

Exp

endi

ture

Pane

lSu

rvey

(ME

PS).

Age

ncy

for

Hea

lthca

reR

esea

rch

and

Qua

lity.

CI

indi

cate

sco

nfide

nce

inte

rval

;M

SA,

met

ropo

litan

stat

istic

alar

ea.

Tab

leA

-13.

Hea

lthC

are

Use

for

Chi

ldre

nA

ged

17Y

ears

and

Und

er,

1999

(Ful

l-Y

ear)

:A

vera

geN

umbe

rof

Vis

its*

Cha

ract

eris

tic

Offi

ce-B

ased

Ave

rage

Num

ber

ofV

isits

95%

CI

Hos

pita

lO

utpa

tient

Ave

rage

Num

ber

ofV

isits

95%

CI

Hos

pita

lIn

patie

nt

Ave

rage

Num

ber

ofD

isch

arge

s95

%C

I

Em

erge

ncy

Dep

artm

ent

Ave

rage

Num

ber

ofV

isits

95%

CI

Den

tal

Ave

rage

Num

ber

ofV

isits

95%

CI

Pres

crip

tion

Med

icin

es

Ave

rage

Num

ber

ofV

isits

95%

CI

Tota

l4.

3(3

.9,

4.7)

2.0

(1.6

,2.

4)1.

2(1

.1,

1.2)

1.2

(1.2

,1.

3)2.

7(2

.6,

2.8)

4.2

(3.9

,4.

5)

Hea

lthin

sura

nce

cove

rage

Any

priv

ate

Publ

icon

lyU

nins

ured

4.5

4.0

2.7

(4,

5)(3

.4,

4.5)

(2.3

,3)

1.9

2.4

...

(1.5

,2.

4)(1

.6,

3.2)

...

...

...

1.2

1.4

...

(1.2

,1.

2)(1

.3,

1.5)

2.9

1.9

2.3

(2.7

,3)

(1.7

,2)

(1.8

,2.

7)

4.1

4.7

3.1

(3.8

,4.

4)(4

,5.

4)(2

.3,

4)

Age

0–

4y

5–9

y10

–14

y15

–17

y

4.6

4.1

4.2

4.3

(4,

5.1)

(3.3

,4.

9)(3

.6,

4.8)

(3.6

,5)

1.8

2.5

2.0

...

(1.5

,2)

(1.4

,3.

5)(1

.5,

2.5)

...

...

...

...

1.3

1.2

1.2

1.2

(1.2

,1.

4)(1

.1,

1.3)

(1.1

,1.

3)(1

.1,

1.3)

1.5

1.9

3.5

3.3

(1.4

,1.

6)(1

.8,

2)(3

.2,

3.7)

(2.9

,3.

6)

3.7

4.0

4.6

4.8

(3.4

,4.

1)(3

.5,

4.5)

(4,

5.2)

(4,

5.6)

Sex M

ale

Fem

ale

4.5

4.1

(3.9

,5.

2)(3

.7,

4.4)

2.2

1.8

(1.5

,2.

8)(1

.5,

2.1)

1.1

...

(1.1

,1.

2)1.

21.

3(1

.2,

1.3)

(1.2

,1.

3)2.

62.

8(2

.4,

2.7)

(2.6

,3)

4.7

3.7

(4.2

,5.

1)(3

.4,

4)

Rac

e/E

thni

city

Whi

te,

non-

His

pani

cA

fric

anA

mer

ican

,non

-His

pani

cH

ispa

nic

Oth

er,

non-

His

pani

c

4.9

2.8

3.2

3.0

(4.3

,5.

4)(2

.4,

3.2)

(2.9

,3.

6)(2

.5,

3.6)

2.0

...

2.2

...

(1.5

,2.

4)

(1.6

,2.

7)

...

...

...

...

1.2

1.3

1.3

...

(1.2

,1.

3)(1

.2,

1.4)

(1.2

,1.

4)

2.9

2.0

2.1

...

(2.7

,3.

1)(1

.7,

2.2)

(1.9

,2.

3)

4.5

3.6

3.4

...

(4.1

,4.

8)(3

,4.

2)(3

,3.

8)

Pove

rty

,20

0%of

pove

rty

line

$20

0%of

pove

rty

line

3.9

4.5

(3.5

,4.

4)(3

.9,

5.1)

1.8

2.1

(1.5

,2.

2)(1

.6,

2.6)

1.2

...

(1.1

,1.

3)1.

31.

2(1

.2,

1.4)

(1.1

,1.

2)2.

12.

9(1

.9,

2.3)

(2.7

,3.

1)4.

44.

0(3

.9,

4.9)

(3.7

,4.

3)

Perc

eive

dhe

alth

stat

us

Exc

elle

nt,

very

good

,go

odFa

iror

poor

4.2

9.4

(3.8

,4.

6)(6

.7,

12.1

)1.

9..

.(1

.5,

2.3)

1.1

...

(1.2

,1.

2)1.

2..

.(1

.2,

1.3)

2.7

...

(2.6

,2.

8)3.

911

.8(3

.6,

4.1)

(8.9

,14

.8)

Reg

ion

Nor

thea

st5.

4(3

.8,

6.9)

...

...

1.3

(1.2

,1.

4)2.

6(2

.3,

2.9)

4.4

(3.6

,5.

1)M

idw

est

Sout

hW

est

4.0

4.1

4.1

(3.4

,4.

6)(3

.7,

4.4)

(3.5

,4.

7)

...

2.2

...

(1.2

,3.

3)..

.

...

...

...

1.2

1.2

1.3

(1.2

,1.

3)(1

.2,

1.3)

(1.1

,1.

4)

2.7

2.7

2.8

(2.4

,2.

9)(2

.4,

3)(2

.5,

3.1)

4.0

4.4

4.0

(3.5

,4.

4)(4

,4.

8)(3

.4,

4.6)

MSA M

SAN

on-M

SA4.

34.

3(3

.8,

4.8)

(3.8

,4.

8)2.

0..

.(1

.6,

2.5)

1.1

...

(1.1

,1.

2)1.

21.

3(1

.2,

1.2)

(1.2

,1.

4)2.

72.

7(2

.5,

2.9)

(2.4

,3)

4.1

4.6

(3.8

,4.

4)(3

.9,

5.2)

*Sou

rce:

1999

Med

ical

Exp

endi

ture

Pane

lSu

rvey

(ME

PS).

Age

ncy

for

Hea

lthca

reR

esea

rch

and

Qua

lity.

CI

indi

cate

sco

nfide

nce

inte

rval

;M

SA,

met

ropo

lita

nst

atis

tical

area

.E

llips

esin

dica

tesa

mpl

esi

zeis

too

smal

lto

prov

ide

relia

ble

estim

ates

.

Table A-14. Expenditures for Health Care for Children Aged 17 Years and Under, 1999 (Full-Year)*

Characteristic

Number ofChildren

(in thousands)

Percent ofChildren

With AnyExpenditure 95% CI

Average TotalExpenditure

Per Child WithExpenditure 95% CI

Total 72 632 83.6 (82.2, 85) 1013 (895, 1131)

Health insurance coverage

Any privatePublic onlyUninsured

52 05714 657

5918

87.680.855.3

(86, 89.2)(77.7, 83.8)(50.4, 60.1)

1044942838

(912, 1175)(667, 1217)(230, 1447)

Age

0–4 y5–9 y

10–14 y15–17 y

19 70420 98120 31011 638

87.483.082.979.5

(85.5, 89.4)(80.4, 85.5)(80.5, 85.2)(76.7, 82.3)

1047788

11631098

(755, 1339)(633, 944)(957, 1369)(924, 1271)

Sex

MaleFemale

37 24635 386

83.483.8

(81.7, 85.1)(82.1, 85.5)

10051020

(859, 1152)(845, 1195)

Race/Ethnicity

White, non-HispanicAfrican American, non-HispanicHispanicOther, non-Hispanic

46 63311 24811 718

3033

89.371.671.985.4

(87.9, 90.7)(66.8, 76.3)(69.2, 74.6)(80, 90.8)

1154527890646

(989, 1320)(424, 631)(682, 1098)(445, 847)

Poverty

,200% of poverty line$200% of poverty line

28 91643 716

75.888.7

(73.4, 78.2)(87.3, 90.1)

10221007

(780, 1264)(880, 1135)

Perceived health status

Excellent, very good, goodFair or poor

70 0791683

83.594.2

(82, 84.9)(90.1, 98.3)

9184456

(812, 1024)(2437, 6475)

Region

Northeast 12 858 88.3 (85.6, 90.9) 1286 (929, 1644)MidwestSouthWest

17 79524 30517 674

85.980.781.8

(83, 88.8)(77.8, 83.5)(79.4, 84.2)

929919

1013

(710, 1148)(711, 1126)(821, 1205)

MSA

MSANon-MSA

58 93613 636

83.484.5

(81.8, 85)(81.8, 87.2)

9831090

(862, 1104)(749, 1431)

*Source: 1999 Medical Expenditure Panel Survey (MEPS). Agency for Healthcare Research and Quality. Total are average total dollarexpenditures per child for all health care services, including those not shown in the table. CI indicates confidence interval; MSA, metropolitanstatistical area.

Tab

leA

-15.

Exp

endi

ture

sfo

rH

ealth

Car

efo

rC

hild

ren

Age

d17

Yea

rsan

dU

nder

,19

99(F

ull-

Yea

r)*

Cha

ract

eris

tic

Ave

rage

Exp

endi

ture

sPe

rC

hild

With

Exp

endi

ture

sfo

rE

ach

Typ

eof

Hea

lthC

are

Serv

ice

Offi

ce-

Bas

edV

isit

95%

CI

Hos

pita

lO

utpa

tient

Vis

it95

%C

I

Inpa

tient

Hos

pita

lA

dmit

95%

CI

Em

erge

ncy

Dep

artm

ent

Vis

it95

%C

ID

enta

lV

isit

95%

CI

Pres

crip

tion

Med

icin

e95

%C

I

Tota

l29

5(2

69,

322)

1230

(937

,15

23)

7590

(494

3,10

238)

520

(412

,62

8)46

7(4

01,

533)

153

(120

,18

7)

Hea

lthin

sura

nce

cove

rage

Any

priv

ate

Publ

icon

lyU

nins

ured

322

216

199

(290

,35

3)(1

83,

248)

(145

,25

3)

1302

...

...

(940

,16

63)

...

...

...

578

337

...

(434

,72

2)(2

47,

427)

509

229

369

(431

,58

7)(1

74,

285)

(164

,57

5)

139

220

105

(125

,15

3)(6

3,37

7)(5

6,15

4)

Age

0–

4y

5–9

y10

–14

y15

–17

y

303

269

306

312

(261

,34

5)(2

31,

306)

(262

,35

0)(2

60,

363)

1032

1194

1665

...

(622

,14

42)

(743

,16

45)

(100

0,23

31)

...

...

...

...

381

706

523

551

(315

,44

8)(2

93,

1119

)(3

89,

657)

(415

,68

8)

170

267

658

624

(120

,21

9)(2

09,

325)

(530

,78

5)(4

64,

784)

85 174

175

228

(75,

95)

(65,

284)

(148

,20

1)(1

74,

282)

Sex M

ale

Fem

ale

296

295

(265

,32

6)(2

58,

332)

1524 907

(105

5,19

94)

(663

,11

52)

...

...

452

617

(385

,51

9)(3

74,

860)

397

537

(331

,46

4)(4

34,

641)

187

118

(124

,25

0)(1

02,

134)

Rac

e/E

thni

city

Whi

te,

non-

His

pani

cA

fric

anA

mer

ican

,no

n-H

ispa

nic

His

pani

cO

ther

,no

n-H

ispa

nic

327

186

249

240

(293

,36

1)(1

42,

230)

(198

,30

1)(1

70,

309)

1255

...

...

...

(890

,16

20)

...

...

...

...

520

356

752

...

(438

,60

2)(2

53,

459)

(132

,13

71)

514

237

388

...

(433

,59

5)(1

13,

361)

(301

,47

4)

174

102

107

...

(128

,22

1)(7

9,12

4)(8

5,12

8)

Pove

rty

,20

0%of

pove

rty

line

$20

0%of

pove

rty

line

237

328

(204

,26

9)(2

94,

362)

1140

1271

(806

,14

75)

(879

,16

62)

7739

...

(424

2,11

237)

539

504

(320

,75

8)(4

25,

583)

273

534

(227

,32

0)(4

49,

618)

176

140

(92,

260)

(124

,15

6)

Perc

eive

dhe

alth

stat

us

Exc

elle

nt,

very

good

,go

odFa

iror

poor

287

607

(262

,31

3)(4

20,

793)

1140

...

(861

,14

19)

7585

...

(447

3,10

697)

518

...

(405

,63

1)46

6..

.(4

00,

532)

130

734

(116

,14

4)(2

39,

1508

)

Reg

ion

Nor

thea

st28

7(2

41,

333)

...

...

531

(365

,69

7)42

5(3

14,

535)

217

(54,

380)

Mid

wes

tSo

uth

Wes

t

335

260

308

(270

,40

1)(2

27,

293)

(249

,36

7)

...

1686

...

(963

,24

09)

...

...

...

482

405

806

(381

,58

3)(3

26,

483)

(257

,13

56)

430

353

687

(327

,53

3)(2

93,

414)

(474

,89

9)

131

145

137

(105

,15

7)(1

26,

164)

(102

,17

1)

MSA M

SAN

on-M

SA30

126

9(2

70,

332)

(230

,30

8)11

47..

.(8

39,

1456

)68

32..

.(4

151,

9513

)51

852

7(3

87,

649)

(385

,66

9)50

232

1(4

24,

580)

(245

,39

7)15

116

4(1

10,

191)

(122

,20

7)

*Sou

rce:

1999

Med

ical

Exp

endi

ture

Pane

lSu

rvey

(ME

PS).

Tota

lar

eav

erag

eto

tal

dolla

rex

pend

iture

spe

rch

ildfo

ral

lhe

alth

care

serv

ices

,inc

ludi

ngth

ose

not

show

nin

the

tabl

e.C

Iin

dica

tes

confi

denc

ein

terv

al;

MSA

,m

etro

polit

anst

atis

tical

area

.E

llips

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dica

tesa

mpl

esi

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all

topr

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ere

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timat

es.

Tab

leA

-16.

Perc

ent

Dis

trib

utio

nof

Sour

ceof

Paym

ent

for

Tota

lH

ealth

Car

eE

xpen

ditu

res

for

Chi

ldre

nA

ged

17Y

ears

and

Und

er,

1999

(Ful

l-Y

ear)

*

Cha

ract

eris

tic

Tota

lD

olla

rE

xpen

ditu

res

(in

mill

ions

)95

%C

I

Perc

ent

Dis

trib

utio

nof

Sour

ceof

Paym

ent

for

Chi

ldre

nW

ithA

nyE

xpen

ditu

re

Priv

ate

95%

CI

Med

icai

d95

%C

IO

utof

Pock

et95

%C

IO

ther

95%

CI

Tota

l61

478

(53

382,

6957

4)50

.9(4

5.9,

55.9

)17

.1(1

2.5,

21.6

)22

.7(1

9.9,

25.4

)9.

4(5

.7,

13)

Hea

lthin

sura

nce

cove

rage

Any

priv

ate

Publ

icon

lyU

nins

ured

4758

311

152

2742

(40

790,

5437

7)(7

772,

1453

3)(7

08,

4777

)

65.8

...

...

(61.

6,70

)5.

272

.0..

.

(1.2

,9.

1)(6

1.7,

82.4

)25

.4 7.8

35.7

(22.

1,28

.7)

(4.2

,11

.3)

(10.

2,61

.1)

3.7

20.2

64.4

(2.2

,5.

1)(9

.8,

30.6

)(3

8.9,

89.8

)

Age

0–

4y

5–9

y10

–14

y15

–17

y

1803

613

722

1956

910

152

(12

822,

2325

0)(1

076

3,16

680)

(15

876,

2326

2)(8

282,

1202

1)

43.8

49.5

57.3

53.3

(32,

55.6

)(4

1.5,

57.5

)(5

0.3,

64.3

)(4

7.1,

59.6

)

29.7

18.8 8.3

9.2

(17.

2,42

.1)

(13.

4,24

.3)

(5.7

,10

.8)

(5.4

,13

)

11.8

23.5

26.9

32.5

(7.8

,15

.8)

(18.

1,28

.9)

(22.

2,31

.6)

(26.

8,38

.2)

14.7 8.2

7.5

5.0

(4.4

,25

.1)

(4.4

,11

.9)

(2.5

,12

.6)

(2.5

,7.

4)

Sex M

ale

Fem

ale

3122

430

254

(26

021,

3642

6)(2

474

5,35

763)

49.7

52.2

(43.

5,56

)(4

4.9,

59.5

)17

.117

.1(1

1.4,

22.7

)(1

0.2,

23.9

)22

.123

.2(1

8.4,

25.9

)(1

9,27

.3)

11.1 7.6

(4.7

,17

.4)

(4.7

,10

.5)

Rac

e/E

thni

city

Whi

te,

non-

His

pani

cA

fric

anA

mer

ican

,no

n-H

ispa

nic

His

pani

cO

ther

,no

n-H

ispa

nic

4806

042

4475

0016

74

(40

410,

5571

0)(3

155,

5332

)(5

545,

9456

)(8

72,

2475

)

53.0

42.2

43.3

49.1

(46.

9,59

)(3

1.5,

52.9

)(3

2.3,

54.3

)(3

8.2,

60)

14.1

31.4

25.4

27.7

(8.5

,19

.8)

(22,

40.8

)(1

7.9,

32.8

)(1

2.4,

42.9

)

23.6

18.3

19.8

19.8

(20.

3,26

.9)

(12.

4,24

.1)

(12.

4,27

.2)

(11.

2,28

.4)

9.3

8.2

11.5 3.4

(4.7

,13

.9)

(2.7

6,13

.6)

(7,

16)

(1.4

,5.

5)

Pove

rty

,20

0%of

pove

rty

line

$20

0%of

pove

rty

line

2441

039

068

(16

920,

2790

1)(3

353

8,44

597)

30.7

62.5

(21.

3,40

.1)

(57.

6,67

.4)

41.1 3.3

(31.

6,50

.6)

(2.1

,4.

4)16

.326

.3(1

1.6,

21)

(23,

29.5

)11

.9 7.9

(6.2

,17

.5)

(3.1

,12

.8)

Perc

eive

dhe

alth

stat

us

Exc

elle

nt,

very

good

,go

odFa

iror

poor

5371

370

64(4

640

9,61

016)

(352

7,10

601)

54.3

25.3

(49.

4,59

.3)

(13.

3,37

.3)

13.3

45.1

(9.5

,17

.2)

(27,

63.2

)23

.715

.6(2

0.9,

26.5

)(5

.5,

25.6

)8.

614

.0(4

.6,

12.6

)(5

.2,

22.8

)

Reg

ion

Nor

thea

stM

idw

est

Sout

hW

est

1460

214

209

1801

914

648

(10

468,

1873

6)(1

045

1,17

967)

(13

564,

2247

3)(1

086

0,18

436)

38.8

67.0

47.7

51.5

(28.

7,48

.8)

(59.

5,74

.5)

(37.

9,57

.5)

(45.

8,57

.1)

20.3 6.6

24.5

14.9

(8.9

,31

.6)

(3.1

,10

)(1

4.2,

34.8

)(1

0.3,

19.4

)

19.3

22.6

21.5

27.5

(13.

2,25

.4)

(17.

3,27

.9)

(17.

2,25

.8)

(22.

2,32

.7)

21.7 3.8

6.3

6.2

(8.9

,34

.4)

(2.3

,5.

3)(3

.3,

9.4)

(3.4

,9)

MSA M

SAN

on-M

SA48

311

1256

1(4

130

8,55

313)

(836

6,16

755)

52.3

47.2

(47,

57.7

)(3

3.5,

60.9

)13

.230

.8(9

.1,

17.3

)(1

6.5,

45.1

)23

.918

.8(2

0.8,

27)

(14,

23.6

)10

.6 3.2

(6.1

,15

.1)

(1.2

,5.

2)

*Sou

rce:

1999

Med

ical

Exp

endi

ture

Pane

lSu

rvey

(ME

PS).

Age

ncy

for

Hea

lthca

reR

esea

rch

and

Qua

lity.

CI

indi

cate

sco

nfide

nce

inte

rval

;M

SA,

met

ropo

lita

nst

atis

tical

area

.E

llips

esin

dica

tesa

mpl

esi

zeto

osm

all

topr

ovid

ere

liabl

ees

timat

es.

Table B-1. Trends in Children and Adolescent Hospital Discharges Compared to Adult Discharges (Population Ratios), by Region and forthe Nation, 1995–00*

Characteristic

1995

PopulationRatio (SE)

95% LCI& UCI

1996


95% LCI& UCI

1997


95% LCI& UCI

Children (0–17 y)

National total 93.39 (4.31) (84.94, 101.84) 89.15 (4.06) (81.19, 97.11) 91.34 (4.05) (83.40, 99.28)

Age

,1 y1–4 y5–9 y

10–14 y15–17 y†

1179.36 (56.57)39.46 (2.79)18.69 (1.31)19.62 (1.15)50.38 (2.07)

(1068.48, 1290.24)(33.99, 44.93)(16.12, 21.26)(17.37, 21.87)(46.32, 54.44)

1173.08 (56.02)34.73 (2.35)16.53 (1.10)18.17 (1.07)46.93 (1.97)

(1063.28, 1282.88)(30.12, 39.34)(14.37, 18.69)(16.07, 20.27)(43.07, 50.79)

1191.94 (52.56)38.57 (2.67)18.37 (1.40)18.97 (1.30)46.04 (2.08)

(1088.92, 1294.96)(33.34, 43.80)(15.63, 21.11)(16.42, 21.52)(41.96, 50.12)

Expected payer

PrivateMedicaidUninsured

66.58 (3.30)162.14 (9.47)36.94 (4.64)

(60.12, 73.04)(143.59, 180.69)(27.84, 46.04)

66.72 (3.41)158.80 (8.99)31.15 (2.88)

(60.04, 73.40)(141.18, 176.43)(25.50, 36.80)

70.52 (3.44)162.81 (8.47)30.23 (2.04)

(63.77, 77.26)(146.20, 179.42)(26.24, 34.22)

Region

NortheastMidwestSouthWest

94.12 (8.84)93.86 (6.70)93.86 (7.74)91.62 (10.74)

(76.79, 111.45)(80.73, 106.99)(78.69, 109.03)(70.57, 112.67)

90.63 (8.87)91.04 (6.95)88.79 (7.02)86.64 (9.75)

(73.24, 108.02)(77.42, 104.66)(75.03, 102.55)(67.53, 105.75)

91.45 (8.63)980.62 (6.87)94.47 (7.98)87.28 (8.03)

(74.54, 108.36)(77.15, 104.09)(78.83, 110.11)(71.54, 103.02)

Adults (181 y)

National total 146.10 (5.01) (136.28, 155.92) 146.37 (5.17) (136.24, 156.50) 146.54 (4.97) (136.80, 156.28)

Expected payer


95.72 (3.74)328.45 (14.81)46.99 (4.00)

(88.40, 103.05)(299.43, 357.47)(39.15, 54.83)

96.73 (4.03)307.85 (14.44)44.48 (3.05)

(88.83, 104.64)(279.55, 336.16)(38.50, 50.46)

95.23 (3.84)321.05 (14.16)41.56 (2.07)

(87.71, 102.76)(293.29, 348.81)(37.51, 45.60)

Region


162.28 (10.59)147.89 (8.19)153.37 (9.63)117.20 (10.94)

(141.52, 183.04)(131.84, 163.94)(134.50, 172.24)(95.76, 138.64)

160.33 (11.38)147.29 (9.45)154.51 (9.28)119.21 (11.44)

(38.03, 182.63)(128.77, 165.81)(136.32, 172.70)(96.79, 141.63)

160.80 (11.03)147.80 (9.88)154.62 (9.33)119.16 (9.01)

(139.18, 182.42)(128.44, 167.16)(136.33, 172.91)(101.50, 136.82)

*Source: Data are from the Healthcare Cost and Utilization Project, 1995–2000 Nationwide Inpatient Sample (NIS). Agency for HealthcareResearch and Quality. Population ratio indicates population ratio or the number of discharges per 1000 in the US Census population. LCI,lower confidence interval; UCI, upper confidence interval; Differences in CIs may not be apparent because of rounding.

†Comparison of 95% CI suggests significant difference between 1995 and 2000 point estimates.

Table B-1. Extended.

1998


95% LCI& UCI

1999


95% LCI& UCI

2000


95% LCI% UCI

86.75 (4.27) (78.38, 95.12) 92.08 (4.54) (83.18, 100.98) 88.01 (4.39) (79.41, 96.61)

1147.17 (54.43)33.88 (2.75)16.66 (1.45)18.17 (1.45)44.18 (2.21)

(1040.49, 1253.85)(28.49, 39.27)(13.82, 19.50)(15.33, 21.01)(39.85, 48.51)

1187.16 (57.55)40.84 (3.21)19.22 (1.64)20.77 (1.56)44.38 (2.15)

(1074.37, 1299.95)(34.56, 47.13)(16.01, 22.43)(17.71, 23.83)(40.17, 48.59)

1224.16 (62.21)32.41 (2.57)15.59 (1.27)17.33 (1.23)41.87 (2.04)

(1102.23, 1346.09)(27.37, 37.45)(14.00, 18.08)(14.92, 19.74)(37.87, 45.87)

66.95 (3.79)160.28 (9.37)29.53 (2.26)

(59.54, 74.37)(141.91, 178.64)(25.11, 33.96)

69.53 (3.94)164.65 (9.28)36.25 (2.76)

(61.81, 77.24)(146.46, 182.84)(30.84, 41.65)

68.39 (3.95)158.61 (9.04)37.55 (4.63)

(60.65, 76.14)(140.90, 176.33)(28.48, 46.62)

95.91 (12.20)80.87 (6.48)88.12 (7.63)83.53 (8.44)

(72.00, 119.82)(68.17, 93.57)(73.17, 103.07)(66.99, 100.07)

91.77 (11.20)86.93 (7.84)96.38 (8.23)90.96 (9.33)

(69.72, 113.82)(71.56, 102.30)(80.25, 112.51)(72.67, 109.25)

85.98 (9.88)86.02 (7.72)92.39 (8.19)84.93 (9.08)

(66.62, 105.34)(70.89, 101.15)(76.34, 108.44)(67.13, 102.73)

143.77 (5.54) (132.91, 154.63) 143.18 (5.65) (132.11, 154.25) 143.68 (5.67) (132.57, 154.79)

94.86 (4.37)356.63 (18.57)42.30 (2.48)

(86.30, 103.42)(320.24, 393.03)(37.44, 47.16)

89.90 (4.14)353.83 (18.27)46.68 (3.02)

(81.79, 98.02)(318.02, 389.63)(40.75, 52.61)

92.90 (4.34)352.97 (17.50)45.64 (4.32)

(84.39, 101.40)(318.67, 387.27)(37.17, 54.11)

153.51 (13.95)146.38 (10.73)153.01 (9.82)117.38 (10.20)

(126.17, 180.85)(125.35, 167.41)(133.76, 172.26)(97.39, 137.37)

155.24 (14.52)144.97 (10.95)152.56 (10.11)115.63 (9.88)

(126.78, 183.70)(123.51, 166.43)(132.74, 172.38)(96.27, 134.99)

153.57 (14.48)146.46 (10.99)152.00 (9.87)118.68 (10.68)

(125.19, 181.95)(124.92, 168.00)(132.65, 171.35)(97.75, 139.61)

Table B-2. Trends in Mean Length of Stay (LOS) in Days for Children and Adolescent Hospital Discharges, 1995–00*

Characteristic

1995

LOS95% LCI& UCI

1996

LOS95% LCI& UCI

1997

LOS95% LCI& UCI

1998

LOS95% LCI& UCI

1999

LOS95% LCI& UCI

2000

LOS95% LCI& UCI

National total 3.4 (3.2, 3.5) 3.3 (3.1, 3.4) 3.5 (3.3, 3.6) 3.4 (3.3, 3.6) 3.5 (3.4, 3.6) 3.3 (3.2, 3.4)

Age

,1 y1–4 y5–9 y

10–14 y15–17 y

3.13.34.04.83.8

(3.0, 3.3)(3.2, 3.5)(3.7, 4.2)(4.4, 5.1)(3.6, 4.1)

3.13.23.84.53.7

(3.0, 3.2)(3.1, 3.4)(3.6, 4.1)(4.2, 4.8)(3.4, 3.9)

3.33.23.84.63.8

(3.2, 3.5)(3.0, 3.3)(3.6, 4.1)(4.3, 5.0)(3.5, 4.0)

3.33.23.74.43.7

(3.2, 3.5)(3.0, 3.4)(3.5, 4.0)(4.1, 4.7)(3.5, 3.9)

3.43.13.84.74.0

(3.3, 3.5)(3.0, 3.3)(3.6, 4.0)(4.2, 5.1)(3.7, 4.3)

3.32.93.44.23.7

(3.1, 3.4)(2.8, 3.1)(3.2, 3.6)

(14.0, 4.5)(3.5, 3.9)

Expected payer


3.03.83.0

(2.8, 3.1)(3.6, 4.0)(2.5, 3.5)

3.03.72.8

(2.9, 3.1)(3.5, 3.9)(2.5, 3.1)

3.23.92.8

(3.1, 3.3)(3.7, 4.1)(2.7, 3.0)

3.23.82.9

(3.1, 3.3)(3.6, 4.0)(2.7, 3.1)

3.34.02.9

(3.2, 3.4)(3.8, 4.2)(2.7, 3.0)

3.13.72.7

(3.0, 3.2)(3.6, 3.9)(2.6, 2.8)

Region


3.83.33.52.8

(3.4, 4.1)(3.1, 3.6)(3.2, 3.8)(2.4, 3.1)

3.83.33.42.7

(3.4, 4.1)(3.1, 3.5)(3.2, 3.7)(2.4, 2.9)

3.93.43.62.9

(3.5, 4.2)(3.3, 3.6)(3.3, 3.9)(2.6, 3.2)

3.93.43.62.9

(3.5, 4.2)(3.1, 3.7)(3.4, 3.8)(2.6, 3.2)

4.03.43.53.3

(3.7, 4.3)(3.2, 3.6)(3.3, 3.7)(3.0, 3.6)

3.63.43.33.1

(3.3, 3.8)(3.2, 3.7)(3.1, 3.5)(2.8, 3.4)

*Source: Data are from the Healthcare Cost and Utilization Project, 1995–2000 Nationwide Inpatient Sample (NIS). Agency for HealthcareResearch and Quality. LOS indicates length of stay; LCI, lower confidence interval; and UCI, upper confidence interval. Differences in CIsmay not be apparent as a result of rounding.

Tab

leB

-3.

Tren

dsin

Four

Mos

tFr

eque

ntA

ge-S

peci

ficPr

inci

pal

Dia

gnos

esTr

eate

din

US

Hos

pita

ls,

1995

–00*

Age

Con

ditio

n

1995

Perc

ent

95%

LC

I&

UC

I

1996

Perc

ent

95%

LC

I&

UC

I

1997

Perc

ent

95%

LC

I&

UC

I

1998

Perc

ent

95%

LC

I&

UC

I

1999

Perc

ent

95%

LC

I&

UC

I

2000

Perc

ent

95%

LC

I&

UC

I

,1

yL

iveb

orn

Acu

tebr

onch

itis

Pneu

mon

iaO

ther

peri

nata

lco

nditi

ons

85.5 2.3

1.5

1.2

(83.

9,87

.1)

(1.9

,2.

6)(1

.3,

1.7)

(1.0

,1.

3)

86.6 2.1

1.3

1.2

(85.

1,88

.0)

(1.9

,2.

4)(1

.1,

1.4)

(1.0

,1.

3)

85.4 2.4

1.3

1.3

(83.

7,87

.0)

(2.2

,2.

7)(1

.1,

1.4)

(1.1

,1.

5)

86.4 2.2

1.2

1.2

(84.

8,87

.9)

(2.0

,2.

4)(1

.1,

1.3)

(1.0

,1.

3)

84.7 2.6

1.3

1.3

(82.

9,86

.6)

(2.3

,2.

9)(1

.1,

1.4)

(1.1

,1.

5)

87.6 2.3

0.9

1.1

(86.

1,89

.2)

(2.0

,2.

6)(0

.8,

1.0)

(0.9

,1.

3)

1–4

yPn

eum

onia

Ast

hma

Flui

dan

del

ectr

olyt

edi

sord

ers

Acu

tebr

onch

itis

16.1

11.2 9.0

5.4

(14.

9,17

.2)

(10.

4,12

.0)

(8.0

,10

.0)

(4.2

,6.

6)

15.1

11.9

10.6 5.0

(14.

0,16

.2)

(11.

1,12

.7)

(9.6

,11

.6)

(4.0

,5.

9)

14.8

12.6 7.2

5.4

(13.

6,16

.0)

(11.

7,13

.4)

(6.4

,8.

0)(4

.9,

5.9)

15.8

10.6 7.2

4.5

(14.

5,17

.2)

(9.7

,11

.5)

(6.4

,8.

0)(4

.0,

5.0)

14.6

11.7 7.8

5.2

(13.

7,15

.6)

(10.

7,12

.7)

(7.0

,8.

5)(4

.7,

5.6)

14.0

12.6 8.5

5.5

(12.

8,15

.2)

(11.

8,13

.4)

(7.6

,9.

4)(5

.0,

6.0)

5–9

yA

sthm

aPn

eum

onia

Flui

dan

del

ectr

olyt

edi

sord

ers

App

endi

citis

12.2

10.1 4.7

4.6

(11.

3,13

.1)

(9.3

,10

.8)

(4.0

,5.

4)(4

.2,

5.0)

12.6 9.0

4.9

5.0

(11.

6,13

.6)

(8.3

,9.

7)(4

.4,

5.5)

(4.5

,5.

4)

13.4 8.5

3.9

4.5

(12.

3,14

.5)

(7.8

,9.

2)(3

.4,

4.4)

(4.1

,4.

9)

10.3 8.9

3.5

5.2

(9.3

,11

.4)

(8.0

,9.

8)(3

.1,

3.9)

(4.8

,5.

7)

12.6 8.3

3.7

5.2

(11.

3,13

.8)

(7.6

,8.

9)(3

.2,

4.1)

(4.7

,5.

7)

12.0 7.6

4.1

6.1

(11.

0,12

.9)

(6.9

,8.

3)(3

.7,

4.6)

(5.5

,6.

7)

10–1

4y

App

endi

citis

Ast

hma

Aff

ectiv

edi

sord

ers

Pneu

mon

ia

8.0

7.1

5.3

4.1

(7.3

,8.

7)(6

.5,

7.7)

(4.2

,6.

4)(3

.7,

4.4)

8.4

7.5

5.7

3.7

(7.6

,9.

1)(6

.8,

8.3)

(4.4

,7.

0)(3

.4,

4.0)

8.0

7.5

6.2

3.5

(7.3

,8.

7)(6

.9,

8.2)

(4.8

,7.

5)(3

.2,

3.8)

8.3

6.3

5.8

3.8

(7.6

,9.

2)(5

.6,

7.1)

(4.4

,7.

3)(3

.5,

4.2)

7.8

7.3

7.5

3.3

(7.2

,8.

5)(6

.5,

8.0)

(5.6

,9.

3)(3

.1,

3.6)

9.1

6.8

8.3

2.9

(8.3

,9.

9)(6

.2,

7.5)

(6.4

,10

.3)

(2.7

,3.

2)

15–1

7y

Nor

mal

preg

nanc

yan

d/or

deliv

ery

Trau

ma

tope

rine

uman

dvu

lva

Aff

ectiv

edi

sord

ers

Oth

erco

mpl

icat

ions

ofpr

egna

ncy

6.2

6.1

5.0

4.3

(5.6

,6.

8)(5

.6,

6.5)

(4.1

,6.

0)(4

.0,

4.7)

6.2

6.6

5.3

4.3

(5.6

,6.

8)(6

.0,

7.1)

(4.3

,6.

4)(3

.9,

4.7)

5.8

6.6

5.8

4.3

(5.3

,6.

3)(6

.1,

7.2)

(4.7

,6.

9)(3

.9,

4.7)

5.5

6.7

5.6

4.4

(4.9

,6.

0)(6

.2,

7.3)

(4.5

,6.

8)(4

.0,

4.8)

4.6

6.1

7.6

3.9

(4.2

,5.

1)(5

.6,

6.6)

(6.0

,9.

1)(3

.6,

4.3)

4.7

6.7

8.2

4.3

(4.2

,5.

1)(6

.0,

7.3)

(6.6

,9.

7)(3

.9,

4.6)

*Sou

rce:

Dat

aar

efr

omth

eH

ealth

care

Cos

tan

dU

tiliz

atio

nPr

ojec

t,19

95–2

000

Nat

ionw

ide

Inpa

tient

Sam

ple

(NIS

).A

genc

yfo

rH

ealth

care

Res

earc

han

dQ

ualit

y.A

llda

taar

epe

rcen

tof

disc

harg

esfo

rth

eag

egr

oup.

LC

Iin

dica

tes

low

erco

nfide

nce

inte

rval

;U

CI,

uppe

rco

nfide

nce

inte

rval

.D

iffe

renc

esin

roun

ding

may

not

beap

pare

ntas

are

sult

ofro

undi

ng.

Tab

leB

-4.

Tren

dsin

Len

gth

ofSt

ay(L

OS)

for

the

Four

Mos

tFr

eque

ntA

ge-S

peci

ficPr

inci

pal

Dia

gnos

esTr

eate

din

US

Hos

pita

ls,

1995

–00*

Age

Con

ditio

n

1995

LO

S95

%L

CI

&U

CI

1996

LO

S95

%L

CI

&U

CI

1997

LO

S95

%L

CI

&U

CI

1998

LO

S95

%L

CI

&U

CI

1999

LO

S95

%L

CI

&U

CI

2000

LO

S95

%L

CI

&U

CI

,1

yL

iveb

orn

Acu

tebr

onch

itis

Pneu

mon

iaO

ther

peri

nata

lco

nditi

ons

2.8

3.3

4.2

6.7

(2.8

,2.

8)(3

.3,

3.4)

(4.1

,4.

3)(6

.5,

7.0)

2.8

3.2

3.9

6.6

(2.8

,2.

8)(3

.2,

3.3)

(3.9

,4.

0)(6

.3,

6.8)

3.0

3.2

3.9

7.0

(3.0

,3.

0)(3

.2,

3.2)

(3.8

,4.

0)(6

.8,

7.3)

3.1

3.2

3.8

6.6

(3.1

,3.

1)(3

.2,

3.3)

(3.7

,3.

8)(6

.4,

6.9)

3.1

3.1

3.8

7.3

(3.0

,3.

1)(3

.1,

3.2)

(3.7

,3.

9)(7

.0,

7.6)

3.0

3.0

3.6

6.9

(3.0

,3.

0)(3

.0,

3.1)

(3.5

,3.

7)(6

.7,

7.2)

1–4

yPn

eum

onia

Ast

hma

Flui

dan

del

ectr

olyt

edi

sord

ers

Acu

tebr

onch

itis

3.4

2.4

2.3

2.7

(3.3

,3.

4)(2

.4,

2.5)

(2.2

,2.

3)(2

.6,

2.8)

3.2

2.4

2.1

2.7

(3.1

,3.

2)(2

.3,

2.4)

(2.1

,2.

2)(2

.6,

2.7)

3.2

2.3

2.1

2.6

(3.2

,3.

3)(2

.2,

2.3)

(2.1

,2.

1)(2

.6,

2.6)

3.1

2.2

2.1

2.6

(3.0

,3.

1)(2

.2,

2.3)

(2.0

,2.

1)(2

.5,

2.7)

3.1

2.1

2.0

2.5

(3.0

,3.

1)(2

.1,

2.2)

(2.0

,2.

1)(2

.5,

2.6)

14.0 2.1

1.9

2.5

(14.

0,14

.0)

(2.1

,2.

1)(1

.9,

2.0)

(2.4

,2.

6)

5–9

yA

sthm

aPn

eum

onia

Flui

dan

del

ectr

olyt

edi

sord

ers

App

endi

citis

2.6

3.6

2.2

3.8

(2.6

,2.

6)(3

.5,

3.7)

(2.1

,2.

3)(3

.7,

3.9)

2.4

3.5

2.0

3.8

(2.4

,2.

5)(3

.4,

3.6)

(2.0

,2.

1)(3

.6,

3.9)

2.4

3.5

2.0

3.7

(2.4

,2.

4)(3

.4,

3.6)

(2.0

,2.

1)(3

.6,

3.8)

2.4

3.4

1.9

3.5

(2.4

,2.

5)(3

.3,

3.5)

(1.9

,2.

0)(3

.4,

3.6)

2.4

3.4

2.0

3.5

(2.3

,2.

4)(3

.3,

3.5)

(1.9

,2.

0)(3

.4,

3.6)

2.3

3.1

1.8

3.5

(2.2

,2.

3)(3

.0,

3.2)

(1.8

,1.

9)(3

.4,

3.6)

10–1

4y

App

endi

citis

Ast

hma

Aff

ectiv

edi

sord

ers

Pneu

mon

ia

3.4

2.8

11.7 4.5

(3.3

,3.

4)(2

.8,

2.9)

(11.

3,12

.1)

(4.3

,4.

7)

3.2

2.7

10.0 4.5

(3.1

,3.

3)(2

.7,

2.8)

(9.7

,10

.4)

(4.3

,4.

7)

3.2

2.7

9.5

4.5

(3.1

,3.

3)(2

.6,

2.7)

(9.2

,9.

9)(4

.3,

4.7)

3.1

2.7

8.2

4.1

(3.1

,3.

2)(2

.6,

2.8)

(7.9

,8.

5)(3

.9,

4.3)

3.1

2.6

8.7

4.4

(3.1

,3.

2)(2

.6,

2.7)

(8.3

,9.

1)(4

.2,

4.6)

3.0

2.5

7.4

4.0

(2.9

,3.

1)(2

.5,

2.6)

(7.2

,7.

7)(3

.8,

4.1)

15–1

7y

Nor

mal

preg

nanc

yan

d/or

deliv

ery

Trau

ma

tope

rine

uman

dvu

lva

Aff

ectiv

edi

sord

ers

Oth

erco

mpl

icat

ions

ofpr

egna

ncy

1.5

1.7

9.4

2.2

(1.5

,1.

6)(1

.7,

1.7)

(9.1

,9.

7)(2

.2,

2.3)

1.6

1.7

8.1

2.3

(1.6

,1.

7)(1

.7,

1.7)

(7.9

,8.

3)(2

.2,

2.3)

1.8

1.9

7.7

2.3

(1.8

,1.

8)(1

.8,

1.9)

(7.5

,8.

0)(2

.2,

2.4)

1.8

2.0

6.9

2.3

(1.8

,1.

8)(1

.9,

2.0)

(6.6

,7.

1)(2

.3,

2.4)

1.9

2.0

7.2

2.4

(1.9

,1.

9)(2

.0,

2.1)

(7.0

,7.

5)(2

.4,

2.5)

1.9

2.1

6.3

2.4

(1.9

,2.

0)(2

.0,

2.1)

(6.2

,6.

5)(2

.4,

2.5)

*Sou

rce:

Dat

aar

efr

omth

eH

ealth

care

Cos

tan

dU

tiliz

atio

nPr

ojec

t,19

95–2

000

Nat

ionw

ide

Inpa

tient

Sam

ple

(NIS

).A

genc

yfo

rH

ealth

care

Res

earc

han

dQ

ualit

y.L

OS

indi

cate

sm

ean

leng

thof

stay

inda

ys;

LC

I,lo

wer

confi

denc

ein

terv

al;

and

UC

I,up

per

confi

denc

ein

terv

al.

Dif

fere

nces

inC

Ism

ayno

tbe

appa

rent

asa

resu

ltof

roun

ding

.

Tab

leB

-5.

Cha

ract

eris

tics

ofC

hild

ren

and

Ado

lesc

ent

Hos

pita

lD

isch

arge

sC

ompa

red

with

Adu

ltD

isch

arge

s,20

00*

Cha

ract

eris

tics

All

Age

s

Adu

lts(1

81y)

Chi

ldre

n&

Ado

lesc

ents

(0–1

7y)

Chi

ldre

nan

dA

dole

scen

ts

,1

y1–

4y

5–9

y10

–14

y15

–17

y

Tota

lnu

mbe

rof

disc

harg

esFe

mal

eM

ean

leng

thof

stay

,da

ys(S

E)

Adm

itted

thro

ugh

ED

3005

018

450

(61.

4)4.

9(.

01)

1312

0(4

3.7)

6363

3132

(49.

2)3.

3(.

01)

929

(14.

6)

4685

(73.

6)†

2253

(48.

1)3.

3(.

01)

222

(4.7

)

498

(7.8

)†21

9(4

4.0)

2.9

(.01

)22

7(4

5.7)

320

(5.0

)†14

0(4

3.7)

3.4

(.02

)14

8(4

6.1)

356

(5.6

)†16

8(4

7.3)

4.2

(.03

)15

6(4

3.7)

504

(7.9

)†35

2(6

9.9)

3.7

(.02

)17

6(3

5.0)

Exp

ecte

dpa

yer‡

Priv

ate

Med

icai

dU

nins

ured

1390

0(4

6.7)

5098

(17.

0)14

23(4

.8)

3454

(54.

5)23

93(3

7.8)

324

(5.1

)

2607

(55.

9)17

09(3

6.6)

236

5.1)

239

(48.

4)21

8(4

4.0)

24(4

.9)

167

(52.

4)12

6(3

9.5)

16(4

.9)

197

(55.

7)12

8(3

6.1)

17(4

.8)

243

(48.

3)21

3(4

2.4)

31(6

.1)

Bed

size

ofho

spita

l

Smal

lM

ediu

mL

arge

4392

(14.

6)88

02(2

9.3)

1685

0(5

6.1)

1035

(16.

3)18

37(2

8.9)

3491

(54.

9)

700

(14.

9)13

53(2

8.9)

2632

(56.

2)

107

(21.

5)14

4(2

9.0)

247

(49.

6)

70(2

1.8)

92(2

8.6)

159

(49.

6)

71(1

9.9)

100

(28.

0)18

6(5

2.2)

88(1

7.4)

149

(29.

5)26

8(5

3.1)

Ow

ners

hip

ofho

spita

l

Priv

ate,

not

for

profi

tPr

ivat

e,fo

rpr

ofit

Gov

ernm

ent,

non-

Fede

ral

2254

0(7

5.0)

3674

(12.

2)38

35(1

2.8)

4751

(74.

7)68

6(1

0.8)

926

(14.

6)

3493

(74.

6)53

3(1

1.4)

659

(14.

1)

372

(74.

9)41

(8.1

)85

(17.

0)

244

(76.

0)24

(7.6

)52

(16.

4)

274

(76.

9)30

(8.5

)52

(14.

6)

368

(73.

0)58

(11.

5)78

(15.

4)

Urb

anho

spita

lTe

achi

ngho

spita

l25

200

(84.

0)93

29(3

1.1)

5474

(86.

2)22

39(3

5.2)

4053

(86.

7)15

80(3

3.7)

410

(82.

6)20

0(4

0.2)

275

(86.

1)13

9(4

3.4)

309

(86.

9)14

6(4

1.0)

426

(84.

7)17

3(3

4.4)

Reg

ion

Nor

thea

stM

idw

est

6227

(20.

7)69

93(2

3.3)

1122

(17.

6)14

32(2

2.5)

827

(17.

7)10

19(2

1.8)

86(1

7.4)

111

(22.

3)59

(18.

4)74

(23.

0)64

(18.

1)94

(26.

5)85

(16.

9)13

4(2

6.6)

Sout

hW

est

1135

0(3

7.8)

5479

(18.

2)23

62(3

7.1)

1447

(22.

7)17

75(3

7.9)

1064

(22.

7)18

3(3

6.7)

117

(23.

6)11

0(3

4.3)

78(2

4.2)

115

(32.

3)82

(23.

0)18

0(3

5.6)

105

(20.

9)

*Sou

rce:

Dat

aar

efr

omth

eH

ealth

care

Cos

tan

dU

tiliz

atio

nPr

ojec

t,20

00N

atio

nwid

eIn

patie

ntSa

mpl

e(N

IS).

Age

ncy

for

Hea

lthca

reR

esea

rch

and

Qua

lity.

Chi

ldda

tain

clud

edne

wbo

rns.

All

data

are

num

ber

(per

cent

)of

disc

harg

esin

thou

sand

s(p

erce

ntof

colu

mn

tota

l),u

nles

sot

herw

ise

indi

cate

d.SE

indi

cate

sst

anda

rder

ror;

ED

,Em

erge

ncy

Dep

artm

ent.

The

pre-

1998

defin

ition

sof

bed

size

,ow

ners

hip,

and

teac

hing

stat

usw

ere

used

.†P

erce

ntin

dica

tes

perc

enta

geof

tota

lnu

mbe

rof

disc

harg

esfr

omch

ildre

nan

dad

oles

cent

s0

–17

y(p

erce

ntof

row

tota

l).

‡Not

all

perc

enta

ges

tota

l10

0%,

sinc

edi

scha

rges

paid

byM

edic

are

and

othe

rth

ird-

part

ypa

yers

are

not

incl

uded

.

Tab

leB

-6.

Patie

ntC

hara

cter

istic

sfo

rC

hild

ren

and

Ado

lesc

ent

Hos

pita

lD

isch

arge

sby

Stat

e,R

egio

n,an

dfo

rth

eN

atio

n,20

00*

No.

(%)

ofD

isch

arge

s†

Mea

nL

engt

hof

Stay

,D

ays

(SE

)

Adm

itted

Thr

ough

ED

,N

o.(%

)

Age

,N

o.(%

)

,1

y1–

4y

5–9

y10

–14

y15

–17

y

Exp

ecte

dPa

yer,

No.

(%)‡

Priv

ate

Med

icai

dU

nins

ured

2000

NIS

—N

atio

nal

6363

3.3

(.01

)92

9(1

4.6)

4685

(73.

6)49

8(7

.8)

320

(5.0

)35

6(5

.6)

504

(7.9

)34

54(5

4.3)

2393

(37.

6)32

4(5

.1)

Reg

ions

and

stat

es

Nor

thea

stC

onne

ctic

utM

aine

Mas

sach

uset

tsN

ewJe

rsey

1122

(17.

6)65

(1.3

)22

(0.5

)12

6(2

.5)

177

(3.5

)

3.5

(.02

)3.

8(.

03)

4.7

(.08

)4.

0(.

02)

3.7

(.02

)

197

(17.

6)10

(15.

2)3

(13.

1)10

(8.3

)30

(17.

1)

827

(73.

7)49

(74.

6)15

(68.

0)93

(73.

9)12

8(7

2.6)

86(7

.7)

4(6

.8)

2(7

.2)

8(6

.7)

16(8

.8)

59(5

.3)

3(5

.2)

1(6

.0)

7(5

.4)

10(5

.7)

64(5

.8)

4(6

.3)

2(8

.4)

8(6

.6)

11(6

.1)

85(7

.6)

5(7

.1)

2(1

0.3)

9(7

.3)

12(6

.8)

687

(61.

3)42

(64.

3)12

(54.

4)85

(67.

6)13

6(7

6.8)

370

(33.

0)21

(32.

2)9

(39.

0)36

(28.

7)23

(12.

9)

44(3

.9)

2(2

.3)

...

3(2

.1)

15(8

.2)

New

Yor

kPe

nnsy

lvan

iaM

idw

est

Illin

ois

Iow

a

410

(8.2

)25

6(5

.1)

1432

(22.

5)28

3(5

.6)

61(1

.2)

4.0

(.01

)4.

2(.

02)

3.4

(.01

)3.

5(.

01)

3.5

(.03

)

104

(25.

3)50

(19.

7)20

2(1

4.1)

46(1

6.2)

8(1

3.5)

283

(69.

1)16

6(6

4.8)

1019

(71.

1)20

1(7

0.8)

44(7

2.3)

41(9

.9)

22(8

.7)

111

(7.8

)22

(7.8

)5

(8.0

)

27(6

.5)

18(7

.0)

74(5

.2)

15(5

.5)

3(4

.8)

29(7

.0)

24(9

.4)

94(6

.6)

19(6

.7)

4(6

.4)

31(7

.5)

26(1

0.1)

134

(9.4

)26

(9.2

)5

(8.6

)

208

(50.

7)15

4(6

0.1)

858

(59.

9)15

8(5

5.8)

40(6

6.0)

172

(41.

9)91

(35.

5)45

5(3

1.8)

99(3

4.9)

15(2

4.6)

23(5

.6)

6(2

.2)

63(4

.4)

14(4

.9)

5(7

.7)

Kan

sas

Mic

higa

nM

isso

uri

Wis

cons

inSo

uth

54(1

.1)

208

(4.1

)12

6(2

.5)

111

(2.2

)23

62(3

7.1)

3.1

(.03

)3.

3(.

02)

4.0

(.03

)3.

9(.

03)

3.3

(.01

)

...

32(1

5.3)

23(1

8.0)

16(1

4.4)

320

(13.

6)

40(7

3.6)

152

(73.

1)84

(67.

0)77

(68.

8)17

75(7

5.1)

4(7

.9)

17(8

.2)

12(9

.3)

8(7

.3)

183

(7.7

)

2(4

.0)

11(5

.5)

8(6

.3)

6(5

.5)

110

(4.7

)

3(5

.5)

12(6

.0)

10(7

.8)

9(7

.9)

115

(4.9

)

5(8

.9)

15(7

.1)

12(9

.7)

12(1

0.5)

180

(7.6

)

32(5

9.1)

148

(71.

0)60

(48.

0)73

(65.

4)11

18(4

7.3)

15(2

8.8)

52(2

4.9)

56(4

4.7)

34(3

0.6)

1009

(42.

7)

2(4

.2)

4(1

.8)

4(2

.8)

3(3

.1)

159

(6.8

)Fl

orid

aG

eorg

iaK

entu

cky

Mar

ylan

dN

orth

Car

olin

a

336

(6.7

)19

5(3

.9)

77(1

.5)

100

(2.0

)17

5(3

.5)

3.8

(.01

)3.

9(.

03)

3.7

(.03

)3.

5(.

02)

3.7

(.02

)

62(1

8.6)

17(9

.0)

9(1

2.2)

17(1

6.7)

20(1

1.4)

232

(69.

1)14

7(7

5.1)

51(6

6.8)

74(7

3.5)

129

(74.

0)

31(9

.3)

14(7

.3)

8(1

0.8)

7(7

.1)

13(7

.6)

20(5

.9)

8(4

.3)

5(6

.4)

5(5

.3)

8(4

.9)

24(7

.0)

10(5

.4)

5(6

.6)

6(5

.9)

10(5

.7)

29(8

.7)

15(7

.9)

7(9

.4)

8(8

.2)

14(7

.8)

167

(49.

7)87

(44.

3)35

(45.

6)60

(60.

0)79

(45.

4)

135

(40.

1)88

(45.

3)34

(44.

5)37

(36.

6)75

(42.

9)

25(7

.5)

10(5

.4)

2(2

.7)

2(2

.1)

10(5

.8)

Sout

hC

arol

ina

Tenn

esse

eTe

xas

Vir

gini

aW

est

Vir

gini

a

89(1

.8)

126

(2.5

)55

0(1

0.9)

142

(2.8

)35

(0.7

)

3.5

(.03

)3.

7(.

02)

3.8

(.01

)3.

7(.

03)

3.2

(.04

)

12(1

3.9)

24(1

8.6)

74(1

3.4)

20(1

4.2)

6(1

8.5)

60(6

8.0)

91(7

2.4)

397

(72.

3)10

2(7

1.5)

24(6

8.5)

9(9

.9)

11(8

.5)

45(8

.2)

11(7

.9)

4(1

1.3)

6(6

.2)

7(5

.2)

27(5

.0)

8(5

.5)

2(6

.6)

6(6

.8)

7(5

.6)

32(5

.9)

10(6

.8)

2(5

.8)

8(9

.1)

10(8

.2)

48(8

.7)

12(8

.3)

3(7

.9)

34(3

7.8)

57(4

4.9)

237

(43.

1)91

(63.

8)13

(37.

7)

49(5

4.8)

62(4

8.8)

250

(45.

4)39

(27.

6)16

(45.

7)

4(4

.2)

3(2

.8)

47(8

.5)

7(4

.7)

1(4

.2)

Wes

tA

rizo

naC

alif

orni

aC

olor

ado

Haw

aii

1447

(22.

7)12

3(2

.5)

810

(16.

1)94

(1.9

)26

(0.5

)

3.1

(.01

)2.

9(.

02)

3.4

(.01

)3.

4(.

02)

3.3

(.05

)

210

(14.

5)16

(12.

8)11

3(1

3.9)

13(1

3.9)

4(1

4.4)

1064

(73.

6)92

(74.

3)59

7(7

3.7)

71(7

5.8)

19(7

5.4)

117

(8.1

)9

(7.4

)61

(7.5

)6

(6.6

)2

(8.5

)

78(5

.4)

6(4

.8)

42(5

.2)

4(3

.9)

1(4

.6)

82(5

.7)

7(5

.3)

49(6

.0)

5(5

.4)

1(4

.7)

105

(7.3

)10

(8.2

)61

(7.5

)8

(8.4

)2

(6.8

)

792

(54.

7)54

(44.

1)42

1(5

1.9)

62(6

5.6)

14(5

3.1)

559

(38.

6)56

(45.

6)34

2(4

2.3)

24(2

6.0)

7(2

7.4)

57(4

.0)

6(4

.6)

24(3

.0)

6(6

.6)

...

Ore

gon

Uta

hW

ashi

ngto

n

66(1

.3)

68(1

.4)

116

(2.3

)

3.1

(.02

)3.

8(.

04)

3.2

(.02

)

7(1

0.4)

7(1

0.5)

17(1

4.4)

50(7

6.1)

54(7

8.4)

86(7

4.6)

4(6

.3)

4(6

.5)

9(7

.5)

3(4

.3)

2(3

.5)

5(4

.7)

4(5

.5)

3(4

.7)

7(5

.8)

5(7

.8)

5(6

.8)

8(7

.3)

37(5

6.4)

51(7

4.9)

64(5

5.7)

21(3

2.1)

13(1

9.8)

48(4

1.7)

4(6

.1)

2(2

.7)

1(1

.1)

*Sou

rce:

Dat

aar

efr

omth

eH

ealth

care

Cos

tan

dU

tiliz

atio

nPr

ojec

t,20

00N

atio

nwid

eIn

patie

ntSa

mpl

e(N

IS)

(nat

iona

lan

dre

gion

ales

timat

es)

and

Stat

eIn

patie

ntD

atab

ases

(sta

tefig

ures

).A

genc

yfo

rH

ealth

care

Res

earc

han

dQ

ualit

yan

dC

ontr

ibut

ing

Stat

eD

ata

Part

ners

.C

hild

ren

data

incl

uded

new

born

s.A

llda

taar

enu

mbe

r(p

erce

nt)

ofdi

scha

rges

inth

ousa

nds

(per

cent

ofro

wto

tal)

unle

ssot

herw

ise

indi

cate

d.SE

indi

cate

sst

anda

rder

ror;

ED

,E

mer

genc

yD

epar

tmen

t.E

llips

esin

dica

tefe

wer

than

1000

disc

harg

es.

†Per

cent

indi

cate

spe

rcen

tage

ofto

tal

num

ber

ofdi

scha

rges

from

child

ren

and

adol

esce

nts

0–1

7y

(per

cent

ofco

lum

nto

tal)

.‡R

owpe

rcen

tage

sdo

not

tota

l10

0%,

sinc

edi

scha

rges

paid

byM

edic

are

and

othe

rth

ird-

part

ypa

yers

are

not

incl

uded

.

Table B-7. Characteristics of Children and Adolescent Hospital Discharges by Expected Payer, 2000*

Characteristics

Expected Payer

Private Medicaid Uninsured

Number of dischargesMean length of stay, days (SE)Admitted through ED

3454 (54.3)3.1 (.01)

429 (12.4)

2393 (37.6)3.7 (.01)

408 (17.0)

324 (5.1)2.7 (.02)

63 (19.4)

Bed size of hospital

SmallMediumLarge

505 (14.6)956 (27.7)

1993 (57.7)

436 (18.2)754 (31.5)

1204 (50.3)

54 (16.8)72 (22.3)

197 (60.9)

Ownership of hospital

Private, not for profitPrivate, for profitGovernment, non-Federal

2808 (81.3)333 (9.6)314 (9.1)

1634 (68.3)285 (11.9)474 (19.8)

193 (59.6)30 (9.2)

101 (31.2)

Urban hospitalTeaching hospital

3072 (88.9)1233 (35.7)

1981 (82.8)852 (35.6)

272 (84.2)98 (30.4)

*Source: Data are from the Healthcare Cost and Utilization Project, 2000 Nationwide Inpatient Sample (NIS). Agency for HealthcareResearch and Quality. Children data included newborns. All data are number (percent) of discharges in thousands unless otherwise indicated.SE indicates standard error; ED, Emergency Department. The pre-1998 definitions of bed size, ownership, and teaching status were used.

Tab

leB

-8.

Hos

pita

lC

hara

cter

istic

sfo

rC

hild

ren

and

Ado

lesc

ent

Hos

pita

lD

isch

arge

s,by

Stat

e,R

egio

n,an

dfo

rth

eN

atio

n,20

00*

Hos

pita

lB

edSi

ze

Smal

lM

ediu

mL

arge

Ow

ners

hip

ofH

ospi

tal

Priv

ate,

Not

For

Profi

tPr

ivat

e,Fo

rPr

ofit

Gov

ernm

ent,

Non

-Fed

eral

Urb

anH

ospi

tal

Teac

hing

Hos

pita

l

2000

NIS

—N

atio

nal

1035

(16.

3)18

37(2

8.9)

3491

(54.

9)47

51(7

4.7)

686

(10.

8)92

6(1

4.6)

5474

(86.

0)22

39(3

5.2)

Reg

ions

and

stat

es

Nor

thea

stC

onne

ctic

utM

aine

Mas

sach

uset

tsN

ewJe

rsey

200

(17.

8)17

(25.

8)6

(25.

1)7

(5.4

)18

(10.

4)

429

(38.

3)23

(35.

5)8

(35.

6)51

(40.

4)47

(26.

7)

493

(43.

9)25

(37.

6)8

(36.

2)65

(52.

1)11

2(6

3.3)

1060

(94.

5)64

(98.

8)21

(93.

9)11

8(9

3.7)

171

(97.

0)

26(2

.3)

0(0

.0)

...

5(4

.3)

0(0

.0)

36(3

.2)

...

...

2(1

.4)

5(2

.7)

1035

(92.

3)61

(94.

1)12

(54.

9)11

2(8

9.1)

176

(99.

8)

736

(65.

6)53

(81.

4)11

(50.

6)82

(65.

1)11

1(6

2.8)

New

Yor

kPe

nnsy

lvan

iaM

idw

est

Illin

ois

Iow

a

31(7

.6)

47(1

8.3)

238

(16.

7)43

(15.

1)13

(21.

6)

140

(34.

1)10

7(4

2.0)

433

(30.

2)87

(30.

7)16

(25.

9)

276

(67.

3)10

6(4

1.5)

761

(53.

1)16

6(5

8.4)

39(6

4.6)

342

(83.

3)24

4(9

5.5)

1264

(88.

2)25

9(9

1.3)

46(7

6.8)

7(1

.8)

1(0

.3)

27(1

.9)

6(2

.1)

0(0

.0)

60(1

4.7)

...

141

(9.9

)12

(4.3

)14

(23.

2)

391

(95.

3)21

9(8

5.6)

1191

(83.

2)25

2(8

8.8)

40(6

5.8)

311

(75.

9)15

4(6

0.3)

530

(37.

0)13

8(4

8.7)

32(5

3.2)

Kan

sas

Mic

higa

nM

isso

uri

Wis

cons

inSo

uth

8(1

4.3)

17(8

.2)

30(2

4.1)

28(2

5.6)

269

(11.

4)

9(1

7.6)

57(2

7.5)

24(1

9.1)

46(4

1.2)

558

(23.

6)

40(7

3.7)

152

(73.

3)79

(62.

5)40

(36.

2)15

35(6

5.0)

32(6

0.2)

196

(94.

2)10

4(8

2.4)

106

(95.

1)14

73(6

2.4)

9(1

7.6)

0(0

.0)

8(6

.3)

...

438

(18.

6)

11(2

1.0)

12(5

.8)

14(1

0.8)

...

451

(19.

1)

32(5

9.9)

185

(88.

9)99

(78.

9)84

(75.

4)19

47(8

2.4)

22(4

1.0)

141

(67.

8)57

(45.

0)54

(48.

1)54

7(2

3.1)

Flor

ida

Geo

rgia

Ken

tuck

yM

aryl

and

Nor

thC

arol

ina

32(9

.7)

15(7

.8)

4(5

.3)

28(2

8.2)

7(4

.2)

50(1

4.8)

72(3

6.9)

21(2

7.5)

29(2

8.8)

20(1

1.3)

250

(74.

5)10

6(5

4.4)

52(6

8.3)

35(3

5.1)

144

(82.

6)

193

(57.

5)19

9(6

1.1)

57(7

4.2)

98(9

7.9)

115

(65.

8)

83(2

4.8)

23(1

1.7)

8(1

0.8)

2(2

.1)

6(3

.5)

56(1

6.7)

50(2

5.4)

10(1

3.2)

...

52(2

9.6)

322

(96.

0)14

3(7

3.0)

40(5

2.0)

93(9

2.9)

132

(75.

6)

133

(39.

7)68

(34.

6)20

(25.

8)60

(59.

9)73

(41.

5)So

uth

Car

olin

aTe

nnes

see

Texa

sV

irgi

nia

Wes

tV

irgi

nia

2(2

.7)

8(6

.7)

53(9

.6)

11(7

.4)

3(7

.2)

27(3

1.0)

31(2

4.4)

194

(35.

2)40

(27.

7)8

(21.

6)

59(6

6.8)

88(7

0.0)

266

(48.

3)80

(56.

5)23

(65.

7)

45(5

0.3)

83(6

5.8)

268

(48.

7)10

0(7

0.3)

28(7

9.0)

19(2

1.3)

21(1

6.9)

179

(32.

4)23

(16.

4)5

(13.

9)

25(2

8.4)

22(1

7.3)

83(1

5.1)

16(1

1.1)

2(6

.8)

68(7

6.9)

104

(82.

3)50

1(9

1.0)

119

(83.

3)19

(53.

3)

44(4

9.5)

66(5

2.0)

228

(41.

4)74

(52.

0)19

(53.

3)W

est

Ari

zona

Cal

ifor

nia

Col

orad

oH

awai

i

328

(22.

7)18

(14.

7)16

1(1

9.9)

22(2

3.8)

13(4

9.7)

416

(28.

8)31

(25.

4)21

5(2

6.6)

29(3

1.2)

13(5

1.4)

702

(48.

6)80

(65.

1)45

0(5

5.5)

57(6

1.0)

7(2

9.0)

954

(66.

0)96

(78.

0)54

4(6

7.1)

55(5

8.1)

17(6

5.3)

194

(13.

4)18

(14.

4)11

3(1

3.9)

21(2

1.9)

...

298

(20.

6)9

(7.2

)12

0(1

4.8)

17(1

8.0)

5(1

7.4)

1301

(89.

9)11

4(9

2.5)

759

(93.

7)83

(87.

8)16

(61.

0)

425

(29.

4)59

(47.

9)32

2(3

9.7)

25(2

6.5)

15(5

6.2)

Ore

gon

Uta

hW

ashi

ngto

n

13(4

9.7)

25(3

6.1)

33(2

8.4)

9(1

3.5)

18(2

6.9)

27(2

3.4)

51(7

6.6)

36(5

2.8)

53(4

5.7)

54(8

1.7)

44(6

4.4)

87(7

5.2)

1(1

.6)

18(2

6.8)

3(2

.2)

11(1

6.7)

5(7

.5)

23(2

0.0)

50(7

5.9)

55(8

1.3)

98(8

4.7)

29(4

3.9)

20(2

9.2)

48(4

1.6)

*Sou

rce:

The

Hea

lthca

reC

ost

and

Util

izat

ion

Proj

ect,

2000

Nat

ionw

ide

Inpa

tient

Sam

ple

(NIS

)(n

atio

nal

and

regi

onal

estim

ates

)an

dSt

ate

Inpa

tient

Dat

abas

es(s

tate

figur

es).

Age

ncy

for

Hea

lthca

reR

esea

rch

and

Qua

lity

and

Con

trib

utin

gSt

ate

Dat

aPa

rtne

rs.

Dat

ain

clud

edne

wbo

rns.

All

data

are

num

ber

(per

cent

)of

disc

harg

esin

thou

sand

s.E

llips

esin

dica

tefe

wer

than

1000

disc

harg

es.T

hepr

e-19

98de

finiti

ons

ofbe

dsi

ze,

owne

rshi

p,an

dte

achi

ngst

atus

wer

eus

ed.

Tab

leB

-9.

Mos

tFr

eque

ntPr

inci

pal

Dia

gnos

es,

Gro

uped

byG

ener

alC

ondi

tion

orB

ody

Syst

em,

Am

ong

Chi

ldre

nTr

eate

din

US

Hos

pita

lsC

ompa

red

toA

dults

Trea

ted

inU

SH

ospi

tals

,by

Age

,20

00*

Prin

cipa

lD

iagn

osis

No.

ofD

isch

arge

sin

Tho

usan

ds(%

ofD

isch

arge

sby

Age

Gro

up)

,1

y1–

4y

5–9

y10

–14

y15

–17

yA

dults

($18

y)

Cer

tain

cond

ition

sor

igin

atin

gin

peri

nata

lpe

riod

Dis

ease

sof

the

resp

irat

ory

syst

emD

isea

ses

ofth

edi

gest

ive

syst

emC

onge

nita

lan

omal

ies

End

ocri

ne,

nutr

ition

al,

met

abol

ic,

and

imm

unity

diso

rder

s

4220

(90.

1)20

2(4

.3)

52(1

.1)

44(0

.9)

33(0

.7)

199

(39.

9)54

(10.

8)17

(3.5

)49

(9.8

)

81(2

5.4)

45(1

4.0)

11(3

.4)

20(6

.3)

46(1

2.9)

54(1

5.2)

18(5

.2)

25(4

.9)

42(8

.4)

13(2

.7)

2735

(9.1

)30

15(1

0.0)

Infe

ctio

usan

dpa

rasi

ticdi

seas

esD

isea

ses

ofth

ene

rvou

ssy

stem

and

sens

eor

gans

Sym

ptom

s,si

gns,

and

ill-d

efine

dco

nditi

ons

and

fact

ors

influ

enci

nghe

alth

Dis

ease

sof

the

geni

tour

inar

ysy

stem

Inju

ryan

dpo

ison

ing

31(0

.7)

25(0

.5)

24(0

.5)

20(0

.4)

16(0

.4)

17(3

.5)

36(7

.3)

16(3

.2)

15(3

.1)

47(9

.5)

21(6

.4)

14(4

.3)

14(4

.3)

47(1

4.7)

17(4

.9)

14(4

.0)

13(3

.7)

60(1

6.8)

12(2

.4)

12(2

.4)

19(3

.8)

70(1

3.8)

1098

(3.7

)15

50(5

.2)

2417

(8.0

)N

eopl

asm

sM

enta

ldi

sord

ers

Dis

ease

sof

mus

culo

skel

etal

syst

eman

dco

nnec

tive

tissu

ePr

egna

ncy,

child

birt

h,an

dpu

erpe

rium

Dis

ease

sof

the

circ

ulat

ory

syst

emD

isch

arge

sw

ithdi

agno

sis

inth

eto

p10

4667

(99.

6)

14(2

.8)

465

(93.

4)

13(4

.1)

14(4

.4)

280

(87.

4)

14(3

.8)

55(1

5.5)

15(4

.2)

306

(86.

1)

11(2

.2)

73(1

4.5)

188

(37.

2)

465

(92.

3)

1868

(6.2

)16

73(5

.6)

1453

(4.8

)44

08(1

4.7)

6834

(22.

7)27

051

(90.

0)

*Sou

rce:

Dat

aar

efr

omth

eH

ealth

care

Cos

tan

dU

tiliz

atio

nPr

ojec

t,20

00N

atio

nwid

eIn

patie

ntSa

mpl

e(N

IS).

Age

ncy

for

Hea

lthca

reR

esea

rch

and

Qua

lity.

Chi

ldda

tain

clud

edne

wbo

rns.

All

data

are

num

ber

(per

cent

)of

disc

harg

esin

thou

sand

s.Pe

rcen

tage

sm

ayno

tm

atch

num

bers

beca

use

ofro

undi

ng.

Tab

leB

-10.

Ten

Mos

tFr

eque

ntPr

inci

pal

Dia

gnos

esA

mon

gC

hild

ren

Trea

ted

inU

SH

ospi

tals

Com

pare

dto

Adu

lts,

2000

*

Prin

cipa

lD

iagn

osis

No.

ofD

isch

arge

sin

Tho

usan

ds(%

ofD

isch

arge

sby

Age

Gro

up)

,1

y1–

4y

5–9

y10

–14

y15

–17

yA

dults

($18

y)

Liv

ebor

nO

ther

peri

nata

lco

nditi

ons

Hem

olyt

icja

undi

cean

dpe

rina

tal

jaun

dice

Shor

tge

stat

ion,

low

birt

hw

eigh

t,an

dfe

tal

grow

thre

tard

atio

nA

cute

bron

chiti

s

4104

(87.

6)52

(1.1

)32

(0.7

)23

(0.5

)10

7(2

.3)

27(5

.5)

Vir

alin

fect

ions

Flui

dan

del

ectr

olyt

edi

sord

ers

Uri

nary

trac

tin

fect

ions

Pneu

mon

iaA

sthm

a

18(0

.4)

25(0

.5)

18(0

.4)

44(0

.9)

17(0

.4)

10(2

.0)

42(8

.5)

10(2

.1)

70(1

4.0)

63(1

2.6)

13(4

.1)

8(2

.5)

24(7

.6)

38(1

2.0)

10(2

.9)

24(6

.8)

1095

(3.7

)

Inte

stin

alin

fect

ions

Oth

erup

per

resp

irat

ory

trac

tin

fect

ions

Non

infe

ctio

usga

stro

ente

ritis

Epi

leps

y,co

nvul

sion

sA

ppen

dici

tisan

dot

her

appe

ndic

eal

cond

ition

s

20(4

.0)

18(3

.6)

16(3

.2)

22(4

.3)

7(2

.1)

10(3

.0)

20(6

.1)

7(2

.0)

32(9

.1)

20(3

.9)

Frac

ture

ofup

per

limb

Mai

nten

ance

chem

othe

rapy

,ra

diot

hera

pySk

inan

dsu

bcut

aneo

ustis

sue

infe

ctio

nsFr

actu

reof

low

erlim

bD

iabe

tes

mel

litus

with

com

plic

atio

ns

10(3

.2)

7(2

.3)

8(2

.4)

8(2

.3)

7(2

.1)

11(3

.0)

9(2

.5)

Oth

erm

enta

lco

nditi

ons

Aff

ectiv

edi

sord

ers

Trau

ma

tope

rine

uman

dvu

lva

Oth

erco

mpl

icat

ions

ofbi

rth,

puer

peri

umaf

fect

ing

man

agem

ent

ofth

em

othe

rN

orm

alpr

egna

ncy

and/

orde

liver

y

12(3

.3)

30(8

.3)

14(2

.9)

41(8

.2)

34(6

.7)

30(5

.9)

24(4

.7)

588

(2.0

)78

5(2

.6)

649

(2.2

)

Oth

erco

mpl

icat

ions

ofpr

egna

ncy

Ear

lyor

thre

aten

edla

bor

Hyp

erte

nsio

nco

mpl

icat

ing

preg

nanc

y,ch

ildbi

rth,

and

the

puer

peri

umU

mbi

lical

cord

com

plic

atio

nsPo

ison

ing

byot

her

med

icat

ion

and

drug

s

22(4

.3)

16(3

.1)

11(2

.2)

10(2

.0)

Cor

onar

yat

hero

scle

rosi

san

dot

her

hear

tdi

seas

eC

onge

stiv

ehe

art

failu

re,

nonh

yper

tens

ive

Non

spec

ific

ches

tpa

in

1360

(4.5

)10

24(3

.4)

793

(2.6

)A

cute

myo

card

ial

infa

rctio

nC

ardi

acdy

srhy

thm

ias

Chr

onic

obst

ruct

ive

pulm

onar

ydi

seas

ean

dbr

onch

iect

asis

Dis

char

ges

with

diag

nosi

sin

top

1044

40(9

4.8)

298

(59.

9)14

6(4

5.4)

151

(42.

4)22

0(4

3.7)

768

(2.6

)64

8(2

.2)

614

(2.0

)83

25(2

.7)

*Sou

rce:

Dat

aar

efr

omth

eH

ealth

care

Cos

tan

dU

tiliz

atio

nPr

ojec

t,20

00N

atio

nwid

eIn

patie

ntSa

mpl

e(N

IS).

Age

ncy

for

Hea

lthca

reR

esea

rch

and

Qua

lity.

Chi

ldda

tain

clud

edne

wbo

rns.

All

data

are

num

ber

(per

cent

)of

disc

harg

esin

thou

sand

s.Pe

rcen

tage

sm

ayno

tm

atch

beca

use

ofro

undi

ng.

health care for children and youth in the united states: 2002 report on trends in access,...

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