Child Health Should Become a Regular Focus of Policy Discussions

October 10, 2016

Kelly Kelleher, MD, MPH, and Steve Allen, MD, MBA, comment on President Obama's special communication regarding health care reform.

The Accountable Care Act has made some notable achievements in adult healthcare, as President Obama argued in his Special Communication.1   However, as executives of a children’s hospital, we must call attention to an unfortunate, but not surprising, issue: the data and findings President Obama presents focus almost entirely on adults.

Admittedly, there is a long way to go before child health becomes a regular focus of policy discussions. Metrics exist that demonstrate how pediatric care affects long-term outcomes in adults, but they have not been standardized. Perhaps more fundamentally, pediatrics does not represent a large enough share of the healthcare dollar to attract attention from most policy makers and business leaders.

However, the ACA’s future direction is crucial to the field of pediatrics, and pediatrics is crucial to the future success of the ACA. In their editorial, Drs. Skinner and Chandra note that the ACA’s health insurance expansion does not necessarily mean the ACA has improved health.2  The act, however, has initiated a much-needed shift away from fee-for-service payments, which reward providers for the volume of care they give; and moved toward value-based payments, which reward quality and value of care.

For the pediatric community, this shift allows us to:

  • Focus on population health, while still treating individual illnesses
  • Incentivize providers and institutions to keep children well
  • Address social determinants, such as poverty and education, by integrating community initiatives with child health programs

Fortunately, here in Ohio, forward-thinking policy makers, Medicaid, providers and insurers have collaborated to address the health needs of children through integrated health care, education and housing initiatives. National policy makers should make these initiatives easier by enabling regulations to expand pediatric accountable care organizations, value-based health care for Medicaid, and pediatric metrics for community health, like those proposed in VITAL SIGNS.3

A national priority should be fostering healthier children as our next generation of healthier, productive adults. Only then will the ACA achieve its most important goals of reducing healthcare costs and improving the overall health of the entire population.


Steve Allen, MD, MBA, is a co-author of this letter.


  1. Obama B. United States Health Care Reform: Progress to Date and Next Steps. JAMA. 2016 Jul 11. doi: 10.1001/jama.2016.9797
  2. Skinner J, Chandra A. The Past and Future of the Affordable Care Act. JAMA. 2016 Jul 11. doi: 10.1001/jama.2016.10158
  3. Institute of Medicine. Vital Signs: Core Metrics for Health and Health Care Progress. Washington, DC: National Academies Press; 2015.

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