Summary

About 12 million American children are not receiving basic preventive health care, such as regular physical examinations or childhood immunizations. GAO looked at how five countries with universal health insurance--England, France, Germany, Japan, and the Netherlands--deliver preventive health care to children. GAO found that they do not rely solely on systems of universal coverage to ensure that children receive services. Instead, they may (1) notify health authorities of new births, which initiates the monitoring and the providing of preventive health services; (2) stress the importance of regular care by targeting new parents for home visits, by providing booklets for maintaining a child's health record, and by conducting information campaigns; (3) provide convenient access to physical examinations by making them available in schools; and (4) facilitate the continuity of care through computer tracking. Before adopting any of these special measures, the United States should study them carefully, given the current limited knowledge of their cost and their real health consequences.

GAO found that: (1) the five countries require parents or hospital officials to notify health authorities of new births, which initiates the children's automatic inclusion in their preventive health care service networks; (2) the countries use home visiting for newborns and health services in schools, which increases access to preventive care; (3) the countries use child health booklets, public information campaigns, and outreach to special populations to foster participation in preventive care; (4) England has adopted a financial incentive program for general practitioners based on the percentage of fully immunized children in their practices; (5) England and the Netherlands require that medical records be systematically collected and centrally maintained for tracking purposes; (6) there were no outcome and cost data to assess the effectiveness of the countries' preventive care; and (7) it is unclear whether the use of similar methods in the United States would increase participation in children's preventive health services, particularly among lower income families.