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This study is the first of its kind to comprehensively assess health and health care use among the more than 100,000 youth residing in Washington, D.C., considering both the children's health service delivery system and the communities where they live, which affect their health. The authors use survey, administrative, and focus group data to describe the health status of District children and their use of health services, with particular attention to changes over time in health status and health care use as well as differences by age, insurance status, and location within the city; assess environmental characteristics that may contribute to or ameliorate poor health outcomes among children; describe community resident and provider perspectives on child health service needs; and consider the implications of the evidence they synthesize for improving children's health in the District. The goal of the study is to lay a factual foundation for advocacy and policy decisions related to children's health in the District, as well as to help inform the allocation of community benefit resources by Children's National Medical Center, a children's hospital in the District.

Table of Contents

  • Chapter One


  • Part I

    Setting the Context

  • Chapter Two

    Infrastructure of the Health Care Delivery System for Children in the District

  • Chapter Three

    Physical and Social Characteristics of District of Columbia Neighborhoods

  • Part II

    Health and Health Care Use Among Children in the District

  • Chapter Four

    Health Insurance, Sociodemographic Characteristics, and Health Status of District Children

  • Chapter Five

    Use of Health Care Among District Children

  • Chapter Six

    Use of Health Care Among District Children in Medicaid Managed Care and Fee-for-Service Medicaid

  • Chapter Seven

    Use of Health Care Among District Children with Special Needs

  • Chapter Eight

    Perspectives on Children's Health and Health Care Among District Parents, Adolescents, and Health Care Providers

  • Part III

    Implications for Improving Child Health

  • Chapter Nine

    Summary and Recommendations

  • Appendix A

    Demographic, Geographic, and Health Plan Information

  • Appendix B

    Analyses of the National Survey of Children's Health

  • Appendix C

    Use of Health Care Services Through Children's National Medical Center

  • Appendix D

    Review of Literature: Physical and Social Environment and Health

  • Appendix E

    Methods: Developing Health Indices

  • Appendix F

    Health Environment Maps

  • Appendix G

    Analyses of Claims and Hospital Discharge Data

  • Appendix H

    Focus Group Methodology and Demographic Characteristics

The research described in this report was supported by the Children's National Medical Center and conducted within RAND Health.

This report is part of the RAND Corporation Technical report series. RAND technical reports may include research findings on a specific topic that is limited in scope or intended for a narrow audience; present discussions of the methodology employed in research; provide literature reviews, survey instruments, modeling exercises, guidelines for practitioners and research professionals, and supporting documentation; or deliver preliminary findings. All RAND reports undergo rigorous peer review to ensure that they meet high standards for research quality and objectivity.

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