PURPOSE
Historically, health insurance has not treated children fairly. Insured services have been oriented to the medical needs of adults, with children's unique needs given poor coverage or, in the instance or preventive care, rare coverage. These biases inherent in private and public health insurance also manifest themselves in the coverage of catastrophic care for children. The objectives of the following recommendations are to rectify some of the structural problems of health insurance that are faced by children, to ensure access to all needed health care services for all children, and to protect families from overwhelming out-of-pocket medical care costs.
PRINCIPLES
To address the needs of children through 21 years of age with illnesses that lead to catastrophic costs, all insurance plans must (1) be available to all children (and pregnant women) without regard to race, religion, national origin, economic status, health or functional status, or existing health insurance coverage; (2) include participation of both private and public sectors; (3) support the development of comprehensive, community-based systems of personal health care for the chronically ill child; (4) cover a broad array of child-specific health services; (5) contain costs through managed care and other means; and (6) require some financing from the child's family in proportion to their ability to pay.
DEFINITION OF CATASTROPHIC NEED
The American Academy of Pediatrics (AAP) defines catastrophic need by relative economic distress. Generally, a child whose family's out-of-pocket medical care costs reach a maximum of 10% of their annual adjusted gross income as reported to the Internal Revenue Services is one who, regardless of health status, income level, or existing insurance coverage, is in need of financial support for further medical expenses.
PS2-36: Incremental Medical Care Costs of Prostate Cancer for Medicare Beneficiaries
