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Financing Principles of Child Health Care
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Financing for child health care should have maximized access to ensure comprehensive quality care for the child and mother. This is the revised statement of policy on child health care financing. The principles stated in the policy are used in evaluating the child health care financing changing structure.
The AAP (American Academy of Pediatrics) supports the insured and universal financial access to achieve quality care for the health of all newborns, children, infants, adolescents, and young adults up to 21 years old, as well as pregnant women. This type of insurance must provide unlimited and comprehensive beneficial package of services on recommended AAP preventive care, chronic and acute care, pregnancy-related care, and emergency care.
Children’s bill of rights on accessing health care system:
1. All pregnant women and children have the right to a comprehensive health care.
2. Financial barriers never prevent pregnant women and children from getting comprehensive health care.
3. The public has the obligation to provide insurance for pregnant women and children if their families cannot afford to do so.
4. The financing mechanism on health care should allow the patient or the family members to select a professional on health care who will provide quality pediatric care.
5. Families must choose pediatricians whose office also serves as medical homes.
6. Managed care plans must never have access restrictions on qualified primary pediatric care, inpatient care, and emergency care reliable with the standard of prudent person or appropriate referral to pediatric surgical specialists and pediatric medical specialists. It is required that all plans should include all subspecialties and inpatient facilities representatives having designated pediatric units.
Financing mechanisms on health care must:
- Cover all the health care needed by pregnant women and children stated in the AAP’s statement of policy.
- Include incentives in promoting care coordination and continuity by primary care pediatricians.
- Recognize appropriate value of evaluated reimbursements, care coordination, management services, and performance of indicated medical surgeries and procedures.
- Incorporate appropriate methods for monitoring and reporting the measurements of quality care specifically given to children including process, access, outcome, structure assessments, and patient satisfaction. Peer reviews from pediatricians must also be included.
- Prohibits insurers of health care from neglecting coverage using the pre-existing condition clauses of exclusion or restrictive severe underwriting medical practices.
- Recommends all health insurance policies to fulfil requirements such as:
• enrolment should not have waiting periods
• no coverage or reimbursement limitation due to recurring or severe chronic illnesses
• no increase on premium rates
• guarantee portability and renewability
- Clearly states the limitations and specifications of all plan on health financing.
- Have flexibility and pluralistic. Standardize programs on requirements and benefits such as payment mechanisms and unified claims forms for efficient administration.
- Encourage access to medical subspecialty, surgical specialty care and quality pediatric primary.
- Clearly defines the health insurer’s policy on medical necessity regarding care and services.
Financing mechanisms that are inequitable contribute to the present stage of preventable morbidity and mortality among pregnant women and children. The AAP, private and public sectors are working together in expanding the health care financing structure. The principles are created for evaluating some proposed changes and integrated to ensure that SCHIP can expand Medicaid and established new programs in providing access to excellent health care.
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