A new report says Utah's children receive health care at one of the lowest costs in the nation, but few of them have the insurance to access it and the quality is below average.

The New York-based Commonwealth Fund recently released its state scorecard for child health system performance. The foundation ranked each state according to access, quality and costs. Utah ranked in the middle of the pack at No. 26 overall.

The state led the nation in lowest personal spending per capita for health care, helping earn it a No. 2 rank for lowest costs. But it was also in the bottom quarter for both quality and access to health care among children. Nearly 14 percent of children up to age 17 lack insurance, the report states, as opposed to 9.1 percent nationally. Among children living below 200 percent of the federal poverty level, 31.1 percent were not insured, almost double the 16.6 percent national average.

Part of the problem could be the formerly periodic nature of the state Children's Health Insurance Program, said Nate Checketts, a bureau director with the state Department of Health. The program is designed to offer health coverage to kids of low-income families -- but up until last July, it had to freeze applications for a time when it hit the state funding ceiling.

"One thing that other states have benefited from is that their programs have always been open," he said.

This spring, lawmakers passed a bill opening the program on an unlimited basis. During the uninterrupted enrollment period in the last year, the number of children enrolled jumped 38 percent to 34,621.

"That's the result of being able to open the program up," Checketts said. "The growth has been a little bit more steady in recent months."

In addition to the obvious problems that a lack of insurance can present during a catastrophe, the long-term effects can be just as dangerous, said Jason Burgess, a spokesman for Intermountain Healthcare's SelectHealth insurance program, one of the Utah's largest providers.

"If you don't have insurance, you put off going to the doctor," he said. "You put off having your regular checkups. You rely on access to an emergency room."

That can lead to problems down the road, said Genevie Gonzalez, operations manager at Mountainland Community Health Center in Provo. Gonzalez said about 73 percent of the people who visit her clinic every day are uninsured, including about a third who are kids.

"It is hard. Depending on what their problem is, if they're left untreated, then of course [problems] can manifest," she said. "If they don't have insurance, a parent may say, 'Oh, let's keep watching this and see what happens.' "

Under Commonwealth's health care quality metrics, Utah fell in the bottom half in all but one area: the rate of hospital admissions for pediatric asthma, where its 91.8 admissions per 100,000 were low enough for fourth place. But follow-ups after specialty care and vaccinations among toddlers teetered near the bottom of the rankings, at No. 49 and No. 47, respectively.

In stark contrast to some of Utah's low marks in other areas of the report, the state came in No. 3 in the catch-all category "potential to lead long, healthy lives." Researchers took into account two numbers there: the rate of infant mortality and the percent of children age 1-5 at moderate or high risk for developmental delay. Utah's infant mortality rate was 5.6 per 1,000 live births, compared to 7.1 among all states -- good enough for No. 8. Results were even better in the second category, where the state earned a No. 4 ranking.

The full report is available at www.commonwealthfund.org.

• Ace Stryker can be reached at 344-2556 or astryker@heraldextra.com.