Leading Health Indicator 1 Access to Quality Health Services Florida 2010 Goal for Children and Youth Improve access to and utilization of high quality, affordable health services for all women of child-bearing age, children, youth and young adults HP 2010 Goal Improve access to comprehensive, high-quality health care services

Barriers to access are financial, personal and institutional/structural. Personal barriers can include language, illiteracy, work hours, cultural and immigrant concerns regarding discrimination or treatment, a belief that one is ineligible for insurance or a service, lack of transportation, and lack of knowledge of available services or health practices. Financial barriers occur when a person cannot afford insurance or has an uncovered expensive service such as when a child is born with a serious health care problem or an accident occurs. Structural concerns include the lack of available medical providers where one lives.

Health insurance is the most important indicator of access to quality health services. Children with ongoing health insurance are more likely to have a medical home, be up-to-date on immunizations and use the emergency room less for care.^(2-4)   Insurance status also affects birth outcomes and use of early ongoing prenatal care. Since the health care of women prior to pregnancy and during pregnancy are important factors in birth outcomes and because the risk of death and morbidity for children is greatest at birth, the next improvement in reducing poor birth outcomes is likely to come from ensuring that all women of child-bearing age have access to health insurance.

Figure 16: U.S. and Florida Insured and Uninsured Women (Age 19 to 65) and Children (Age 0-18), 1999-2000(5,6)

Sources: Urban Institute and Kaiser Commission on Medicaid - Uninsured estimates based on pooled March 2000 and 2001 Current Population Surveys. http://www.statehealthfacts.kff.org : Ethnicity and Race of Florida Children is from the Agency for Health Care Administration, Florida Health Insurance Study: Volume 1 The Telephone Survey http://www.floridahealthstat.com/rga_reports.shtml

Figure 17: Uninsured U.S. Women by Age, 2000 Source: US Census http://www.census.gov/ hhes/hlthins/historic/hihistt2.html

One quarter of young adult females do not have health insurance

Populations most at risk for lack of insurance are poor children whose family income is below 100 percent of poverty, young adults (18 to 24 years of age), women and Hispanics. Adolescents with or without insurance are the least likely to access health care services in a doctor's office. Children with special health care needs and their families have difficulty finding insurance when they become adults.