Children's access to health care, the content and quality of services provided, and the outcomes of care all occur within the context of the health care delivery system. Understanding how health services can improve child health should begin with examining the structure of children's health care and the processes that occur once health professionals and patients interact. Findings from the relatively new scientific field of child health services research provide the pediatric care physician with a more accurate and complete picture of how health care affects child health.[1]

This chapter uses a structure-process-outcome framework to describe the health care delivery system and to analyze its effects on children.[2] Structure refers to financial and organizational arrangements of the delivery system that are present before health professionals and patients interact. Structural elements include the pediatric workforce, child health care delivery sites, financing of services, and the medical home. Assessing the process of care includes investigating the scope of pediatric practice, the content of visits, pediatricians' referrals to specialists, and the quantity of different types of services delivered to children. The chapter concludes with an examination of the connections between pediatric services and child health outcomes.