
Evidence Tools
Forgone Health Care
Introduction
This toolkit summarizes content from the Forgone Health Care Evidence Accelerator and the MCHbest database. The peer-reviewed literature supporting this work can be found in the Established Evidence database. Use the resources below as you develop effective evidence-based/informed programs and measures.
From the MCH Block Grant Guidance. Improving access to quality health services is essential for optimal health in both preventing and treating health conditions. When needed care is not received, health may suffer and conditions may not be prevented or may grow in severity. Common barriers to care include financial burden, insurance coverage, insurance type, language, and parental education.2,3 Adequate insurance and access to a patient-centered medical home can reduce unmet needs for health care.1
Goal. To ensure access to needed health care services for children.
Note. Access other related measures in this Population Domain through the Toolkits page.
Detail Sheet: Start with the MCH Block Grant Guidance
DEFINITION
Numerator: Number of children, ages 0 through 17 years, who are reported by a parent to be unable to obtain needed health care in the past year
Denominator: Number of children, ages 0 through 17 years
Units: 100
Text: Percent
HEALTHY PEOPLE 2030 OBJECTIVE
Related to Access to Health Services (AHS) Objective 04: Reduce the proportion of persons who are unable to obtain or delay in obtaining necessary medical care. (Baseline 4.1% of persons unable to obtain or delayed in obtaining necessary medical care in 2017, Target 3.3%)
Related to AHS 05: Reduce the proportion of persons who are unable to obtain or delayed in obtaining necessary dental care. (Baseline 4.6% in 2017, Target 4.1%)
Related to AHS 06: Reduce the proportion of persons who are unable to obtain or delayed in obtaining necessary prescription medicines. (Baseline 3.4 % in 2017, Target 3.0%)
DATA SOURCES
National Survey of Children’s Health (NSCH)
MCH POPULATION DOMAIN
Child Health and/or Adolescent Health
MEASURE DOMAIN
Clinical Health System
1. Accelerate with Evidence—Start with the Science
The first step to accelerate effective, evidence-based/informed programs is ensuring that the strategies we implement are meaningful and have high potential to affect desired change. Read more about using evidence-based/informed programs and then use this section to find strategies that you can adopt or adapt for your needs.
Evidence-based/Informed Strategies: MCHbest Database
The following strategies have emerged from studies in the scientific literature as being effective in advancing the measure. Use the links below to read more about each strategy or access the MCHbest database to find additional strategies.
Evidence-Informed |
Evidence-Based |
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Mixed Evidence |
Emerging Evidence |
Expert Opinion |
Moderate Evidence |
Scientifically Rigorous |
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Field-Based Strategies: Find promising programs from AMCHP’s Innovation Hub
Emerging:
- Child Development Clinic Services (VA; 2021)
- Child Service Assessments (RI; 2023)
- Expanded Eligibility (WV; 2021)
- Publicly Financed Pediatric Palliative Care Model (FL; 2011)
Promising:
- Flexible Case Management Model to Serve Young Parents (MA; 2020)
- Health Education, Case Management, and Patient Navigation (NY; 2019)
- Home Visiting and Parent Education (VA; 2020)
Best:
- Systems Building Grants (NC; 2018)
2. Think Upstream with Planning Tools—Lead with the Need
The second step in developing effective, evidence-based/informed programs challenges us to plan upstream to ensure that our work addresses issues early and is measurable in “turning the curve” on big issues that face MCH populations. Read more about moving from root causes to responsive programs and then use this section to align your work with the data and needs of your populations.
Move from Need to Strategy
Use Root-Cause Analysis (RCA) and Results-Based Accountability (RBA) tools to build upon the science to determine how to address needs.
Planning Tools: Use these tools to move from data to action
3. Work Together with Implementation Tools—Move from Planning to Practice
The third step in developing effective, evidence-based/informed programs calls us to work together to ensure that programs are implementable and moveable within the realities of Title V programs and lead to improved health outcomes for all people. Read more about implementation tools designed for MCH population change and then use this section to develop responsive strategies to bring about change that is responsive to the needs of your populations.
Additional MCH Evidence Center Resources: Access supplemental materials from the literature
- Find field-based resources focused on addressing lack of health care relevant to Title V programs in the MCH Digital Library.
- Search the Established Evidence database for peer-reviewed research articles related to strategies for addressing lack of health care.
- Request Technical Assistance from the MCH Evidence Center
- MCH Evidence Center Frameworks and Toolkits:
Implementation Resources: Use these field-generated resources to affect change
Practice. The following tools can be used to translate evidence to action to advance this NPM:
- Barriers to Care Questionnaire (Cincinnati Children’s Hospital Medical Center). This tool developed for parents of children with chronic health conditions measures health care access.
- Find Coverage for Your Family State Map (InsureKidsNow.gov). This tool helps families find health care coverage in their state.
Partnership. The following organizations focus efforts on addressing lack of health care:
- Child Health Transformation Resource Center. Supports improvements in pediatric practice.
- National Center for a System of Services for CYSHCN. Advances the system of services for CYSHCN by supporting implementation of the Blueprint for Change for CYSHCN.
References
Introductory References: From the MCH Block Grant Guidance
1 Strickland BB, Jones JR, Ghandour RM, Kogan MD, Newacheck PW. The medical home: health care access and impact for children and youth in the United States. Pediatrics. 2011;127(4):604-611. doi:10.1542/peds.2009-3555 https://publications.aap.org/pediatrics/article-abstract/127/4/604/65081/The-Medical-Home-Health-Care-Access-and-Impact-for?redirectedFrom=fulltext
2 Lichstein JC, Ghandour RM, Mann MY. Access to the Medical Home Among Children With and Without Special Health Care Needs. Pediatrics. 2018;142(6):e20181795. doi:10.1542/peds.2018-1795. https://publications.aap.org/pediatrics/article/142/6/e20181795/76857/Access-to-the-Medical-Home-Among-Children-With-and
3 Wisk LE, Witt WP. Predictors of delayed or forgone needed health care for families with children. Pediatrics. 2012;130(6):1027-1037. doi:10.1542/peds.2012-0668. https://publications.aap.org/pediatrics/article-abstract/130/6/1027/30328/Predictors-of-Delayed-or-Forgone-Needed-Health