State’s health care for kids ranks seventh
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Hawaii ranked seventh in the nation for its child health-care system, according to the Commonwealth Fund Commission.
But even though it got good rankings in health-care cost and access for children, Hawaii still came in 41st in potential of the children to lead healthy lives.
Loretta Fuddy, chief of the state Health Department's Family Health Services Division, was surprised by the low ranking and noted it might be due to assessment of Hawaii's infant mortality rate, which fluctuates; self-reporting by parents giving the state a low ranking for children at risk for developmental disabilities; and obesity and asthma, which are significant problems in Hawaii.
CHILDREN'S HEALTH CARE
Top 10 states in a child health care scorecard and state rankings by categories:
||Potential to lead healthy lives
Source: Commonwealth Fund Commission
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Hawaii's child health-care system was the seventh best in the nation in a nonprofit foundation's "State Scorecard," which a state health official says is "very good."
The state did well in some categories of the scorecard published this week by the Commonwealth Fund Commission but "certainly can do better" in others, said Loretta Fuddy, chief of the state Health Department's Family Health Services Division.
Hawaii ranked first in the nation in a similar scorecard looking at health care for adults and seniors, she noted.
States were scored on 13 indicators for child health care related to access, quality, costs, equity and potential to lead healthy lives.
Fuddy said she was a little surprised at Hawaii's low 41st ranking in the "potential for long healthy lives" category. "That didn't seem right," she said.
But one reason was the way the researchers measured the infant mortality rate, she said. "Hawaii's rate, because of a small number of births, goes up and down."
The study said Hawaii's infant mortality rate was 7.5 deaths per 1,000 live births based on 2002 data. However, the 2005 infant mortality rate was 6.3, Fuddy said. "That's very low and very good for our standing in the nation."
The researchers also looked at 2002-2003 data for the percentage of families or children at risk for developmental disabilities, placing Hawaii 44th in the nation.
That figure was based on self-reporting by parents with concerns for a child, Fuddy said.
As a result, isle families might be a little more alert to the issues, she said.
Obesity and asthma also are significant problems in Hawaii which affect the assessment of children at risk for potential to lead long, healthy lives, Fuddy pointed out.
Hawaii ranked fifth in cost of health care for children, sixth for children's access to health care, 26th for quality of care and 11th for equity, but some of the data was two to five years old.
"The report points out we're doing some very good things in Hawaii," Fuddy said. "We have a very low uninsured rate, and the report is dated. The uninsured rate has continually decreased as we have increased the state health insurance coverage to 300 percent of poverty." Before, it was 200 percent of the poverty level.
More children also have been insured in the State Children's Health Insurance Program, she added.
She said Hawaii does well with screening infants for metabolic disorders -- "virtually 100 percent for hearing disorders" -- and intervention programs.
"But again, we do need to look at issues of asthma, obesity and quality of care. Certainly, we can do a lot better about coordinating services and continually looking at the quality of services being provided."
She said the number of children who have a doctor or medical home must be improved. Hawaii ranked 29th in the nation with a 2003 rate of 45.3 percent.
"They do very well when they're discharged from the hospital, because of Healthy Start and other programs," Fuddy said. But as children age and move from one health provider to another, the rate drops off. "We need to do better to assure medical homes for kids of all ages."
The Health Department also is trying to develop a dental care home program to ensure that children have a dentist, she said, pointing out Hawaii has one of the worst dental decay rates in the nation.
"It's a health education issue," she said.
All states have room for improvement, according to the report, "U.S. Variations in Child Health System Performance: A State Scorecard."
The Commonwealth Fund is a private foundation that supports independent research on health policy reform and high-performance health systems.