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8. Young Children's Access to a Medical Home

A medical home is a team-based health care delivery model led by a physician, physician assistant, or nurse practitioner who provides comprehensive and continuous primary medical care to patients with the goal of obtaining optimal health outcomes. A provider who ensures young children receive coordinated, ongoing, comprehensive care within a medical home engages the child’s family, provides advice to the parents on child development, and works to ensure that the child’s medical and non-medical needs are met. Sometimes, the term “family-centered medical home” is used to describe such care.

Establishing a medical home is important because it allows a patient—particularly one with chronic health conditions requiring multiple services—to access and receive appropriate health services in the context of an overall treatment plan. It also is important for children, young children in particular, because it facilitates tracking development and providing preventive and developmental services. According to a September 2013 report from the University of Iowa, “Medical Homes for Children in Iowa,” having a medical home is associated with increased parent satisfaction, decreased emergency room use, lower rates of hospitalization and more preventive care.

What Can the Data Tell Us?

Data from the National Survey of Children's Health illustrate the number of children who lack a medical home and the substantial variation by race, ethnicity and socioeconomic status (Table 16).  Hispanic children are almost twice as likely as their white, non-Hispanic counterparts to lack a coordinated medical home. Children living below the poverty level are significantly less likely to have a coordinated medical home than children at or above 400 percent of poverty. States vary greatly in the proportion of children lacking a medical home. These data are useful for targeting resources and tailoring programs to those lacking equitable access to ongoing, comprehensive care within a medical home. At the same time, examining overall rates helps identify the general needs of children.

Table 16. Percentage of children 0-17 reported as lacking coordinated, ongoing comprehensive care within a medical home by race/ethnicity and poverty level, U.S. and states, 2011-2012