The vast majority of adopted children not only have insurance (95 percent), but have been consistently covered over the prior 12 months (91 percent) and have adequate insurance (78 percent). Additionally, 60 percent of adopted children receive coordinated, ongoing, comprehensive care within a medical home;i see Figure 17.
Adopted children fare better than or as well children in the general population on health insurance and health care measures. Adopted children are more likely than children in the general population to have health insurance (95 compared with 91 percent) and to have had insurance continuously over the previous 12 months (91 compared with 85 percent). Similar percentages of adopted children and children in the general population have adequate health insurance and have a medical home;ii see Figure 17.
Figure 17. Percentage of children according to measures of health context and insurance, by adoptive status
Adequacy and consistency of health insurance coverage is similar across adoption types. Children adopted from foster care are as likely as the other two groups of adopted children to have any health insurance coverage and to have adequate coverage. In addition, children adopted from foster care are slightly more likely than privately adopted U.S. children to have been consistently insured for the prior 12 months (94 compared with 88 percent).iii However, children adopted from foster care are less likely than children adopted internationally to receive coordinated, ongoing, comprehensive care within a medical home (58 compared with 67 percent);iv see Figure 18.
Figure 18. Percentage of adopted children according to measures of health context and insurance, by adoption type
The type of health insurance coverage varies by adoption type. Over half of children adopted from foster care (59 percent) and one-third of children adopted privately from the United States are covered by public health insurance. In contrast, internationally adopted children are far more likely than children adopted from foster care and privately adopted U.S. children to be covered by private insurance (92 percent, compared with 37 and 61 percent, respectively).
Health status: To assess health status, we examined parents’ answers to the question, “In general, how would you describe [your child’s] health? Would you say [his/her] health is excellent, very good, good, fair, or poor?”
Special health care needs: Children with special health care needs are those who currently experience at least one of five consequences attributable to a medical, behavioral, or other health condition that has lasted or is expected to last for at least 12 months. The consequences include: 1) ongoing limitations in ability to perform activities that other children of the same age can perform, 2) ongoing need for prescription medications, 3) ongoing need for specialized therapies, 4) ongoing need for more medical, mental health, or educational services than are usual for most children of the same age, and 5) the presence of ongoing behavioral, emotional, or developmental conditions requiring treatment or counseling.
Moderate or severe health difficulties: Parents reported whether a doctor had ever told them that their child had any one of 16 health conditions.23 Children whose parents reported at least one condition for their child that was currently moderate or severe were categorized as having a moderate or severe health problem.
Impacted by asthma: Parents first reported whether a “doctor or health care provider has ever told” them that their child had asthma. Parents who responded positively also reported whether the child currently still had asthma, and, if so, whether the symptoms were “mild, moderate, or severe.” We grouped children into three categories: those who had never been diagnosed with asthma, those with currently moderate or severe asthma symptoms, and those with mild or non-current asthma.
Missed more than 10 school days due to illness or injury: This indicator was based on parental reports regarding children ages 6 and older who were enrolled in school.
Injured during the prior 12 months: This measure was assessed for children ages 0 to 5 depending on parents’ reports that their child had “been injured and required medical attention.”
HEALTH INSURANCE AND HEALTH CARE MEASURES
Health insurance coverage: The NSCH first asked parents, “Does [your child] have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicaid?” If a respondent answered “yes,” the NSCH asked whether the child was covered by “Medicaid or the State Children’s Health Insurance Program, S-CHIP?” We categorized children whose parents reported that their child was covered by Medicaid or S-CHIP as being covered by public insurance. We categorized all other children whose parents reported that they had health insurance as being covered by private insurance. However, some share of children may be covered both by public and private insurance.
Consistency of coverage: We assessed whether children were consistently insured over the 12 months prior to the survey, never insured over the year, currently insured but lacked coverage at some time during the year, or currently uninsured but had coverage at some time during the year.
Adequate health insurance: This measure depends on parents’ responses to three questions: 1) “Does [your child’s] health insurance offer benefits or cover services that meet (his/her) needs?” 2) “Does [your child's] health insurance allow him/her to see the health care providers he/she needs?” And 3) “How often are [out-of-pocket] costs reasonable?” Children were categorized as having adequate insurance if their parents responded “usually” or “always” to each of the questions (or had no out-of-pocket costs and said usually or always to the other questions).
Care is received in a medical home: This measure is based on five components, each of which must have been present in order to categorize children as receiving care in a medical home. The five components are: The child 1) has a usual source for sick care, 2) has a personal doctor or nurse, 3) has no problems obtaining referrals when needed, 4) receives effective care coordination (i.e., the family is very satisfied with doctors’ communication with each other and with doctors’ communication with other programs, and the family usually or always gets sufficient help coordinating care if needed), and 5) receives family-centered care, including at least one visit in the past year. Family-centered care is care in which doctors usually or always spend enough time with the patient, listen carefully to complaints or concerns, are sensitive to families’ values and customs, provide needed information, and make the family feel like a partner, and in which families have interpretation services available when needed.