Academic journal article Journal of School Health

How Volunteer Health Professionals Brought Medical Care to Pasadena's Uninsured Children

Academic journal article Journal of School Health

How Volunteer Health Professionals Brought Medical Care to Pasadena's Uninsured Children

Article excerpt

A child who is not healthy cannot be effective in the classroom. In a 1990 Carnegie Foundation National Survey of Teachers,|1~ 53% of 20,000 teachers interviewed reported poor health as a major problem interfering with classroom learning for their students.

The proportion of American children lacking adequate health care is increasing rapidly. An estimated 12 million children have no health insurance; their numbers rose twice as fast in the 1980s as uninsured adults.|2~ In most families, at least one parent works full time, but the job may lack insurance benefits or cover only the employee. Dependent coverage at $150 a month or more is often out of the family's financial reach.|3~ The Children's Defense Fund predicts that by the year 2000, more than half of American children will have no health insurance through their parents' employers.|3~

Low-income uninsured working families are hardest hit; their income puts them over the limit for Medicaid coverage so health care expenses must be paid out-of-pocket. Access to low-cost services often is limited, requiring long waits, traveling long distances, and loss of at least a day's wages for one parent.|3~ Well-child physicals and dental care are usually seen as luxuries.|4~

When preventive and early care is not affordable or accessible, a family will wait and watch a sick child. Only if problems worsen is the child brought to the hospital emergency room. By delaying treatment, the child may develop complications that are more expensive to treat and potentially life-threatening. Emergency department care may represent only a temporary solution. The immediate condition is treated, but after paying $100 or more in hospital fees, the family is frequently unable to afford prescriptions or follow-up care required to cure or control the underlying problem.|3~

Such problems can affect any community, including Pasadena, California. Located northeast of Los Angeles, Pasadena is perhaps better known for its historic architecture, Tournament of Roses, and affluent neighborhoods. However, Pasadena's population of 131,000 is heterogeneous, representing many racial and ethnic groups. One finds more percentages of households with incomes below $10,000 and more with incomes above $75,000 than in the Los Angeles County population as a whole.|5~ Pasadena operates its own school district with 22,000 students. Most schoolchildren (54.7%) are concentrated in the lowest-income section of the city; 79% are members of minority groups and 17% have limited proficiency in English.|6~ Compared to the national average of 20.6%,|7~ one-third of Pasadena public school students have no health insurance. At some schools, an estimated 50% to 75% are uninsured.|6~ This article describes an innovative plan Pasadena developed to meet children's health needs.

SCHOOL NURSES ON THE FRONT LINES

With nowhere else to turn, a child who broke a wrist on Saturday might wait until Monday morning to see the nurse. School nurses saw increasing numbers of acute and chronic problems requiring medical attention including fractures, infections, seizures, vision problems, respiratory problems, nutrition problems, rashes and severe tooth decay. Yet, there was virtually nowhere to refer the uninsured child. In assessing minor problems, school nurses also discovered cardiac problems, enlarged livers, severe growth retardation -- problems not discovered earlier because these children had not received physical examinations.|3-8~

In earlier years, school nurses could send a note home advising parents to take the child to a physician. Today, children often have no family physician and low-cost services are not readily accessible. The one walk-in clinic operated by Pasadena's public health department is open only one evening a week. A child might need to wait weeks, even months, for an appointment at a Los Angeles County clinic. Many families resort to using Pasadena's two major hospital 24-hour emergency rooms as walk-in clinics, paying the standard fee for services. …

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