Health Care Access and Special Care Needs Are Associated With Developmental Well-Being at Age 3

Young children’s developmental well-being—comprised of multiple domains, including physical health, motor skills, social-emotional functioning, self-regulation, and early language and math skills—is important to their overall well-being. Developmental progress in these domains is shaped by a combination of factors, including the child’s individual characteristics, family environment, access to needed services, and broader community and societal contexts. Together, these influences form a dynamic ecology that can either support or restrict healthy development. In 2022, a national indicator of children’s developmental well-being and school readiness, Healthy and Ready to Learn (HRTL), was introduced in the National Survey of Children’s Health (NSCH). This new measure for young children ages 3–5 provides opportunities to better understand the developmental well-being of young children in the United States and the child, family, and community conditions that contribute to being healthy and ready to learn.

A child’s environment, experiences, and access to health care can play a critical role in supporting their healthy early development. Access to high-quality primary care and adequate health insurance coverage can ensure that children receive preventative services, developmental screening, and timely treatment when needed while also reducing emergency room visits. A medical home—a model of comprehensive, coordinated, patient- and family-centered primary care—is typically defined by five components: having a personal doctor or nurse, having a usual source for sick care, experiencing family-centered care, the ease of getting needed referrals to other care and services, and experiencing effective care coordination. Adequate and continuous health insurance refers to aspects of a child’s insurance coverage, including plans that allow children to see necessary providers, coverage of needed services, and affordable out-of-pocket costs.

Because children with special health care needs (CSHCN) engage with the health care system differently than children without them (non-CSHCN; e.g., more frequent interactions, connecting to more types of providers, greater needs for referrals), and because underlying conditions can independently affect development, we present findings separately for CSHCN and non-CSHCN.

In this brief, we examine how access to a medical home—and to each of the five individual components—and having adequate insurance coverage relate to children’s developmental well-being across the five domains of HRTL. To attempt to isolate the associations between various aspects of health care access and quality and development at age 3, our analyses also account for the social and economic contexts of the child and family.

This brief is part of a series that summarizes evidence on how children’s daily experiences and environments relate to their developmental well-being at age 3, as measured by HRTL. Age 3 is a key transition period between toddlerhood and preschool, making it an important point for understanding the impact of prenatal-to-age-3 investments and identifying strategies to support children’s health and readiness to learn. These analyses focus on malleable factors—i.e., those that can be influenced or changed, and especially those influenced by families, communities, and public policies and programs that may reduce developmental risks and promote positive outcomes.