‘Medical home’ kids do better in school

USC (US) — Undocumented children who have access to health insurance perform better in math and in reading and miss fewer days of school due to illness or injury.

The new findings are the first to show a direct health benefit to children from what primary care practitioners call a “medical home,” which is health care that is comprehensive, coordinated, family-centered, and culturally effective.

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“If you can connect kids to medical homes, there are potentially big payoffs,” says Gregory D. Stevens, assistant professor of family medicine at the University of Southern California and lead author of two recently published studies. “We found that there is a strong association between high-quality medical care, and health improvement and school engagement.”

Medical homes are not buildings or services, but an approach to provide patients with comprehensive primary care, according to the American Academy of Pediatrics, and are encouraged by health reforms passed into law by the Patient Protection and Affordable Care Act of 2010.

While those health reforms don’t apply to undocumented immigrants, Stevens and co-author Michael R. Cousineau, associate professor of research, evaluated the efficacy of Healthy Kids. The decade-old county-led program provides affordable health insurance for children of low-income families who do not qualify for state insurance programs like Medi-Cal and Healthy Families, most notably, undocumented children.

At the time of data collection in 2009, Healthy Kids was offered in 24 of 58 California counties, providing comprehensive medical, dental, and vision coverage tp about 70,700 children statewide.

The researchers surveyed 4,011 children from 21 of the 24 Healthy Kids programs (including the largest in Los Angeles),which included mostly Latino children in low-income, undocumented, and predominantly Spanish-speaking families.

Nearly 95 percent of the 2,230 families that were reached cooperated. The sample was divided into three groups: established enrollees (in the program for one year or longer), new enrollees (less than one year), and children on a waiting list.

For the study, published in the journal Medical Care, the researchers found that those enrolled in Healthy Kids were more likely to have a regular source of health care and reported better medical home experiences than the children on a waiting list. Children who were enrolled in the program for more than a year reported the best medical home experiences among the three groups.

In a separate study published online by Health Services Research, the researchers report that children who had better medical home experiences missed fewer days at school and performed better overall in math and in reading.

For example, for every one-point increase in the medical home total score, the odds of missing fewer than three school days due to illness or injury in the past school year increased by 12 percent. Among the measured indicators of medical home quality, access most strongly was associated with improved health and school engagement.

“It supports the argument to keep providing affordable health insurance for undocumented kids,” Stevens says. “Since these children are going to be left out of health care reform, the studies show the unique value of these public-private programs, like Healthy Kids, that were created to give them coverage.”
Public health officials agreed.

“These families who have no other access to health insurance, they are so grateful to get their child into the health care system,” says Kena Burke, former director of the Healthy Kids program in San Luis Obispo, Calif.

“For the most part, children are well. But if they contract an ear infection or common cold and their parents don’t have access to insurance and have to pay cash, economic choices have to be made: Should I pay rent or give medical care to my children? It’s hard.”

The research was funded by The California Endowment, a private health foundation, and First 5 California, a tobacco tax-funded state agency that focuses on providing children’s services.

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