How Child Health Financing and Payment Mitigate and Perpetuate Structural Racism.

Area of Science:

• Health policy
• Pediatric health equity
• Healthcare financing

Background:

• Commercial and public insurance are primary sources of health financing for children and youth.
• Significant racial and ethnic disparities exist between populations served by commercial and public insurance plans.
• This segregation contributes to health and healthcare disparities.

Purpose of the Study:

• To examine the role of health financing in perpetuating health disparities among children and youth.
• To analyze the impact of Medicaid and CHIP on racial and ethnic minority children.
• To identify potential policy changes to mitigate these disparities.

Main Methods:

• Analysis of health financing sources for children and youth.
• Examination of racial and ethnic demographics served by different insurance types.
• Review of Medicaid and CHIP characteristics, including eligibility, enrollment, and covered services.

Main Results:

• Medicaid and CHIP insure over 50% of US children, with higher rates among racial and ethnic minorities.
• Medicaid provides significant short- and long-term health and developmental benefits.
• State-by-state variations in Medicaid, low payment rates, and enrollment practices contribute to a "separate and unequal" system for minority children.

Conclusions:

• Medicaid and CHIP are crucial for child health but exhibit systemic inequities.
• Policy reforms such as strengthening national standards, assuring coverage, and incorporating risk adjustment could reduce racial disparities.
• Addressing structural issues in health financing is essential for achieving child health equity.