NAPNAP Position Statement on Access to Care

The National Association of Pediatric Nurse Practitioners (NAPNAP), an organization that advocates for children, believes that children’s health is a priority for our nation and that our health care system must maintain and improve the health of America’s children. Unfortunately, the United States currently ranks 37th in the world in overall health system performance and 72nd in population health (Blendon et al 2001, World Health Organization 2000). NAPNAP believes that enhanced access to care for all will improve health outcomes and overall health status of children.

NAPNAP supports the promotion of primary health care as a model that encourages continuous and comprehensive access to care. Access to care is defined as having a usual source of care (i.e., a primary health care provider of choice) without barriers to services resulting from financial or insurance restrictions, lack of available providers, or other difficulties (Pincus et al., 2005). Nurse practitioners (NPs) provide cost-effective, primary care services including health education, health promotion, disease prevention, and access to community resources (Reavis, 2004).

Clearly, adequate access to health care services may significantly influence health outcomes (Gresenz et al 2006, Stevens et al 2006). Children with private health insurance are more likely to have a usual source of health care and to receive a variety of preventive health services in comparison with children who do not have a usual source of care, are uninsured, or receive public insurance (Gresenz et al.). Consequently, a substantial number of children (primarily Black and Hispanic children) in America remain uninsured without a usual source of health care in spite of various policy initiatives (Pincus et al., 2005).

Children’s health status varies among ethnic and socioeconomic groups and is influenced by barriers to primary care among low-income, homeless, minority, non–English-speaking, and uninsured children (American Academy of Pediatrics [AAP] Committee on Pediatric Emergency Medicine, 2000; Gresenz et al.; Mullin and Ambrosia 2005, Pincus et al 2005, Reavis 2004; Stevens et al.). Children with special health care needs are at risk for fragmented primary care and limited access to specialized health care services (Rhoades Smucker, 2001). In rural areas children may have limited access to providers because qualified pediatric health care clinicians are not available or are not designated as primary care providers (Lindeke & Jukkala, 2005).

Universal health care insurance coverage is a critical factor for improving the care of children with health problems. The State Children’s Health Insurance Program (SCHIP) was developed to provide health insurance for eligible children and high-quality primary health care from a regular source. By 2003, nearly 4 million children were enrolled in SCHIP (Health Care Financing Administration, 2001). Families who are aware of SCHIP are more likely to have SCHIP insurance and to receive regular primary care and timely immunizations (Sun, Sangweni, Butts, Nguyen, & Ingster, 1999).

NAPNAP believes it is essential for all children (infants through young adults) to have access to comprehensive and preventive health care from a team of qualified pediatric clinicians, including pediatricians, pediatric subspecialists, and pediatric NPs. Comprehensive care includes health maintenance (ranging from prenatal to young adult), acute illness/injury management, chronic illness care, mental health care, and emergency care.

To promote access to care, NAPNAP supports:

NAPNAP believes that all children should have access to comprehensive primary health care services through the provision of insurance to the uninsured and choice in the selection of a primary health care professional to provide quality care.