Children who live in Maine have access to one of the top health care systems in the country, but it comes at a cost, according to a new report from the Commonwealth Fund, a private, nonpartisan foundation that promotes better access, improved quality and greater efficiency in health care.

The report, initially released in May, was revised and reissued with more recent data this month. It shows that Maine’s child health system is second only to those of Iowa and Vermont in overall performance and ranks among the top 14 states in every measure – except for its cost, which is among the highest in the nation.

The report also said that Maine’s infant mortality rate is the lowest of all the states.

Elinor Goldberg, president and chief executive officer of the Maine Children’s Alliance, said Thursday that policymakers here must work to drive down spending without sacrificing quality. Despite the costs, she said, the report represents “an excellent snapshot of how we’re doing in Maine, and the truth is, we’re doing much better than most of the country.”

The study measures five broad performance areas: access, quality, costs, equity and “potential to live healthy lives.”

Under access, Maine ranks 14th best of all the states, as measured by high rates of private and public health care insurance among children in 2005 and 2006. Only 7 percent of Maine children under 18 years of age had no insurance coverage, compared with a national average of 11.3 percent. For the subset of children in low-income families, the rate in Maine jumped to 13.9 percent, compared with the 19 percent national rate.

Massachusetts ranked first in the nation in the access category, and Florida ranked lowest.

In quality of care, Maine ranks fifth-best. The rating is based on several subcategories, including vaccine compliance, preventive medical and dental visits, and access to a primary care “medical home” that refers, coordinates and follows up on care received from medical specialists. Massachusetts ranked highest in the quality category and Oklahoma ranked lowest. Data in this category are drawn from several different years, beginning in 2001.

At $6,540 per person, Maine spent more on health care costs per capita than every state except Massachusetts and the District of Columbia in 2004, the most recent year for which data are available. At $11,289, the average cost of an employer-based health insurance policy for a family was higher here than in all but nine states and the District of Columbia. The combined measures drove Maine’s rank to 46th in the nation.

Goldberg said Maine’s spending is out of control for several reasons, but that demanding “evidence-based” practice from health care providers would improve quality and efficiency while holding down costs. Evidence-based practices are medical interventions that have been tested and proved to be effective.

The report notes that states with the lowest costs also rank lowest in the other categories, with the exception of Hawaii.

Maine ranked third in the equity category, which measures disparity in health care based on insurance coverage, income and race and ethnicity. Utah had the least disparity, while Nevada had the most. The data are drawn from a 2005 survey.

“Potential to lead healthy lives” measures infant mortality rates from 2002 and the percentage of children ages 1 to 5 at risk for developmental delays in 2003. At a rate of 4.3 infant deaths per 1,000 live births, Maine’s infant mortality rate is the lowest in the nation. And with an estimated 20.7 percent of young children at risk for some form of developmental delay, Maine ranks seventh. The combined scores give Maine the second-best score in the category, behind Vermont. Louisiana had the lowest score in the category.

Goldberg said health care coverage is key to providing quality care to children. Maine policymakers decided during the 1980s – “when there was some money in the budget”- to provide the highest level of care to youngsters enrolled in MaineCare, the state’s Medicaid program for low-income children, she said.

To the state’s credit, according to Goldberg, coverage for routine prenatal care, regular well-baby and well-child checkups, screenings for developmental problems and other preventive services remains intact despite hard economic times.

MaineCare also covers some low-income parents, making it more likely that they will seek care for their children, she said.

The 1997 approval of the federal S-CHIP program – the States Children’s Health Insurance Program – extended coverage to children from slightly higher-income families.

“In Maine, we cut the number of uninsured children in half with SCHIP,” Goldberg said. The program now covers about 15,000 children in Maine. Both MaineCare and SCHIP require states to contribute about 25 percent of the cost of coverage, with federal dollars making up the balance.

Goldberg said Congress must reauthorize SCHIP next year, with expanded income eligibility guidelines. Efforts to do so last year met with a threatened veto from President Bush and the possible discontinuation of the program altogether.

The report may be read in its entirety on the Web site of the Commonwealth Fund, www.commonwealthfund.org.

mhaskell@bangordailynews.net

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