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Ranking the States on Child Health Care

The first-ever state-by-state health system scorecard to focus on children's health care finds wide differences across the country in the quality of care delivered, as well as disparities in access to services, insurance costs, and health outcomes, among other areas.

The Commonwealth Fund report U.S. Variations in Child Health System Performance: A State Scorecard, released on May 28, ranked states on 13 indicators of access, quality, costs, equity, and healthy outcomes. While no single state was at the top of all five categories, some states far surpassed others in overall performance on child health care. Leading the state rankings were Iowa, Vermont, Maine, Massachusetts, and Ohio.

The report estimates that if all states performed as well as the top states:

  • an additional 4.6 million children nationwide would have health insurance
  • 11.8 million more children would get their recommended yearly medical and dental check-ups
  • 1.6 million fewer children would be at risk for developmental delays
  • 10.9 million more children would have a medical home
  • nearly 800,000 more children would be up-to-date on their vaccines.

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Still, there is room for improvement in even the highest ranked states, the authors found. "In looking at the country as a whole, we found that, while there are pockets of excellence, there is no one state or region that is doing as well as it could be," said Fund Vice President Edward L. Schor, M.D., a coauthor of the report. "The good news is we know improvements can be made because we didn't judge these states based on a pie-in-the-sky standard; we judged them against one another."

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