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Children and the Patient Protection and Affordable Care Act: opportunities and challenges in an evolving system
David Keller1, Lisa J Chamberlain2
1Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colo.
Insights
The Patient Protection and Affordable Care Act (ACA) impacts child health, requiring adaptations to payment and delivery models. Child health professionals must advocate for pediatric needs within evolving healthcare systems to prevent harm.
Area of Science:
- Pediatric Health Policy
- Healthcare System Reform
- Child Health Services Research
Background:
- The Patient Protection and Affordable Care Act (ACA) of 2010 primarily targeted adult healthcare but has significant implications for pediatric care.
- Pediatric illness epidemiology shows a dispersed population of medically fragile children and a large group with developmental/behavioral health issues facing disparities.
- Previous healthcare reforms offer insights into successful child health delivery innovations.
Purpose of the Study:
- To analyze the potential impacts of the ACA on child healthcare delivery and payment.
- To identify necessary adaptations in ACA models to meet the unique needs of children.
- To outline strategies for child health professionals to ensure pediatric needs are addressed in evolving healthcare systems.
Main Methods:
- Review of the Patient Protection and Affordable Care Act's provisions related to healthcare access, quality, and workforce.
- Analysis of the evolving epidemiology of pediatric illnesses and associated health disparities.
- Synthesis of lessons learned from previous child health delivery system innovations.
Main Results:
- The ACA includes provisions that could improve pediatric access, quality of care, and support the pediatric workforce.
- However, most ACA payment and delivery models were not designed with children's specific needs in mind and require adaptation.
- Significant health disparities persist among children with developmental and behavioral health issues.
Conclusions:
- The ACA presents both opportunities and challenges for child healthcare.
- Adaptation of ACA payment and delivery models is crucial to effectively address pediatric needs.
- Proactive clinical care, research, education, and advocacy by child health professionals are essential to integrate child health programs and prevent unintended harm.
Abstract:
The Patient Protection and Affordable Care Act (ACA), passed in 2010, focused primarily on the problems of adults, but the changes in payment for and delivery of care it fosters will likely impact the health care of children. The evolving epidemiology of pediatric illness in the United States has resulted in a relatively small population of medically fragile children dispersed through the country and a large population of children with developmental and behavioral health issues who experience wide degrees of health disparities. Review of previous efforts to change the health care system reveals specific innovations in child health delivery that have been designed to address issues of child health. The ACA is complex and contains some language that improves access to care, quality of care, and the particular needs of the pediatric workforce. Most of the payment models and delivery systems proposed in the ACA, however, were not designed with the needs of children in mind and will need to be adapted to address their needs. To assure that the needs of children are met as systems evolve, child health professionals within and outside academe will need to focus their efforts in clinical care, research, education, and advocacy to incorporate child health programs into changing systems and to prevent unintended harm to systems designed to care for children.
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