Investing in the Healthiest Generations of Children: Why We Must Pay for Health
April 2026
By: R. Lawrence Moss, MD, FACS, FAAP
President and CEO, 无码专区 Children鈥檚 Health
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For too long, the national conversation about health care has focused on a familiar set of questions: Who pays? How much does it cost? How do we control spending? These important questions miss a more fundamental one: What, exactly, are we paying听for?
In 2024, the U.S. spent听听听on 鈥渉ealth care鈥 鈥斕 yet we are the least healthy among them. Very few of our payment models actually pay for health as an outcome. Instead, they pay for the volume and complexity of medical care, regardless of whether that care makes patients healthier. Worse still, United States鈥 health systems make more when people are sicker.
We need to be paying for听health听by asking simple but powerful questions: What if hospitals and health systems could be more successful financially by keeping their patients healthier? What if payers more strongly rewarded preventing chronic illness, reducing the need for unnecessary emergency and inpatient care, and keeping children with congenital conditions as healthy as possible 鈥 and more strongly penalized systems that were unsuccessful?听
Our doctors, nurses, and caregivers are doing the best they can within a broken system. But if we want dramatic changes to our health outcomes, we need to give them additional tools and flexibility to treat the underlying causes of poor health in our patients 鈥 namely, the drivers of health 鈥 and align payment with the outcomes we seek to achieve.听
Research has long shown that medical care only accounts for about 15% of a child鈥檚 health. The other 85% is driven by outside factors like access to nutritious food, freedom from violence, quality education, literacy, and protection from adverse childhood experiences.听
In a pay for health system, there is flexibility to invest in both traditional medical care and interventions to address health more broadly. Sometimes the most effective solution to keep a child healthy is to address the root cause of an illness, not just treat the symptoms.听
Consider a child with poorly controlled asthma. We can keep treating flare after flare in the emergency department, or we can send someone into the home to understand and remediate any environmental conditions or circumstances contributing to the problem. Maybe dust, pet dander, or mold in the home is triggering the child鈥檚 exacerbations, or maybe their family is struggling to afford medications. Both approaches treat disease, but only one of those approaches actually creates health through prevention.
Pay for health models also force us to think differently about time horizons. The benefits of investing in children don鈥檛 always show up on next year鈥檚 balance sheet. Healthy children are far more likely to become healthy adults, reducing the burden of chronic disease later in life. As a society, we spend enormous sums of money managing conditions like heart disease, diabetes, cancer, and Alzheimer鈥檚 once they are fully established in adulthood 鈥 often for marginal improvement. If we invested a fraction of those resources earlier in life, we could prevent disease from taking hold or escalating and profoundly change health trajectories.
That long-term view exposes one of the biggest barriers to paying for health: the 鈥渨rong pocket problem.鈥 When we invest in education or food security now, the health care system, more specifically the health insurance industry will reap the benefit years later. People also switch insurance plans multiple times over the course of their lives. This disincentivizes health insurance companies from investing in long-term efforts to create health. If they make the investment in childhood, a competitor may reap the benefits in adulthood. All of this makes it hard for any single payer or provider to justify the investment alone.
The solution lies in collaboration. Alignment of incentives, strong partnerships with state Medicaid agencies, and shared accountability across sectors can help align goals and resources within a community. Instead of sitting on opposite sides of the table 鈥 providers asking for more revenue and payers trying to spend less 鈥 we need to sit on the same side and determine how to use available resources to benefit our children most.
Policy plays a critical role as well. Medicaid, for example, covers in the United States. Thoughtful state and federal policies can accelerate pay for health models by encouraging shared metrics, supporting innovation, and rewarding outcomes that truly matter.
Shifting to a pay for health system will not be easy. It requires trust, patience, and a willingness to rethink deeply established systems. But if we want a healthier nation, we must understand what health is, pay for health, and start with children.
About Dr. Moss
R. Lawrence Moss, MD, FACS, FAAP is president and CEO of 无码专区 Children鈥檚 Health. Dr. Moss will write frequently in this space about how children鈥檚 hospitals can address health-related social needs and create the healthiest generations of children.