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Journal of Urban Health : Bulletin of the New York Academy of Medicine logoLink to Journal of Urban Health : Bulletin of the New York Academy of Medicine
. 1998 Dec;75(4):751–771. doi: 10.1007/BF02344505

Creating systems of developmental health care for children

Miles Hochstein 1,2,3,✉, Neal Halfon 1,2,3,4, Moira Inkelas 5
PMCID: PMC3456017  PMID: 9854239

Conclusion

The value of innovation must be measured against the costs, financial and political, associated with changing the current employer-based insurance system and the Medicaid, Title V, Title XXI/SCHIP, and other federal and state programs that supplement it. Although imperfect, this system still provides most children with insurance, and in the near term, it will need to continue to do so. Administrators, child advocates, and politicians understand how it works and how to make it work for many children. Yet, no close observer of the children's health “nonsystem” can escape the uneasy awareness that uninsurance, access barriers, and inadequate benefit packages and a lack of attention to developmental monitoring and services continue to constitute serious problems, particularly for lower-income children. However, many of the very trends and forces that complicate and are undermining the current children's health care system may suggest the potential shape of solutions. For example, the desire of payers to control costs and the consequent growth of large integrated managed-care organizations that focus primarily on cost control issues also has created new opportunities to improve quality. The key to quality improvement seems to be the improved measurement and evaluation techniques that more-integrated organizations can potentially bring to bear on developmental health. Another key to a more developmental approach to health is the creation of community oversight mechanisms, possibly in the form of outcomes trusts or health insurance purchasing cooperatives, that allocate funding for services based on a larger vision of developmental health outcomes. To do this, communities will first need to develop a vision of developmental health and then to begin to create the outcomes trusts that can coordinate the full range of services needed to promote developmental health. As communities develop a shared vision of developmental and contextual health promotion, the contemporary emergence of integrated managed-care organizations may ultimately prove to have been a necessary precursor to more-comprehensive “three-dimensionally” integrated systems of developmental health care for all children.

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Footnotes

This article builds on the arguments first published in Developing a System of Care for All: How the Needs of Vulnerable Children Inform the Debate, by Neal Halfon and Miles Hochstein, in R. Stein, ed.,Health Care for Children: What's Right, What's Wrong, What's Next. New York: Hospital Fund of New York; 1997.

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