U.S. Kids Not Getting Needed Health Care

WEDNESDAY Oct. 10, 2007 -- Kids in the United States aren't getting the health care they need, especially in the area of prevention, a new study shows.

"Children in the U.S. receive only 46 percent of the care that they should be getting, so they receive worse care than adults in this country, who get 55 percent of needed care," said study author Dr. Rita Mangione-Smith, a researcher at Seattle Children's Hospital Research Institute and an associate professor of pediatrics at the University of Washington School of Medicine in Seattle.

"This is a real wake-up call for the American public," added study senior author Elizabeth McGlynn, associate director of Rand Health. "It's easy to be complacent when you don't look at things, but we've shown that care for kids is way below what [we] would hope to see, and I hope that the attention that we can bring to bear from this study will cause us to take action that can improve care for kids today. We will, as a country, will be better off if we take serious action."

Both Smith and McGlynn spoke at a teleconference on Wednesday to announce the results.

The findings, which are in the Oct. 11 issue of the New England Journal of Medicine, come on the heels of a presidential veto of the SCHIP bill, which would provide health-care coverage to millions of additional children in this country.

"[The study] is just one more reason why the veto should be overridden," said Dr. Lisa Simpson, director of the Child Policy Research Center at Cincinnati Children's Hospital Medical Center. "The study clearly shows that quality of care for children far too often falls short of what it could be. And, particularly for preventive care, what are the barriers to preventive care? Not having health insurance is a well-documented barrier."

"And the bill contains some of the most important provisions for quality health care for children in the history of this country," Simpson added.

Information on the quality and safety of adult health-care in the United States has been well-documented, but information on children's health care has been scant, the study authors stated.

Smith and her colleagues analyzed outpatient medical records for 1,536 children in 12 U.S. metropolitan areas to see how actual care compared with 175 quality indicators.

On average, children in the study received 46.5 percent of the indicated care; 67.6 percent of the indicated care for acute medical problems, 53.4 percent of indicated care for chronic medical conditions, and 40.7 percent of the indicated preventive care.

Quality varied according to the clinical area, ranging from 92 percent adherence for respiratory tract infections to only 34.5 percent for preventive services for teens.

Fewer than 50 percent of children who reached 2 years of age during the study period were fully immunized.

Only 31 percent of children aged 3 to 6 had their weight measured at their annual check-up. "How do we catch a child at risk for obesity if we don't look?" Smith said. "How do we prevent complications if we don't follow weight?"

Similarly, only 19 percent of seriously ill infants had the right lab tests, only 44 percent of those with asthma were on the right medication, and only 38 percent of children were appropriately screened for anemia in the first two years of life.

And these results were a best-case scenario. "The majority of these children were white, middle- to upper middle-class with private health insurance," Smith said. "Most people assume they're getting excellent health care, and, unfortunately, they're not."

Gaps in preventive care were among the most glaring.

"As a pediatrician, I was shocked by some of our findings, especially those related to preventive care and screening," Smith said. "Prevention is the bulk of what we do. I even re-screened the charts, because I couldn't believe the results."

Why are these deficits happening?

Partly because of the structure of the health-care system, which pressures physicians to see as many patients as possible in a short period of time, Smith suggested. "In a lot of cases, the annual check-up gets a 10-minute slot on a doctor's schedule," she said. "How can we accomplish all we are supposed to do and give parents time to voice their concerns?"

Physicians also need to be trained better in preventive care. Right now, the emphasis is on dealing with acute illness.

Parents, too, have a role to play. "Parents need to be quite proactive with their child's health care," Smith said.

And perhaps a checklist for doctors might improve matters.

"We're human, just like airplane pilots are human, and having that tool would go a long way to solving this problem," Smith said.

But much of the solution lies with policymakers.

"Our study shows that health-care quality is an issue in and of itself apart from the access problem, which is an equally important but separate problem," Smith said. "People who are promoting better access to care for children through the SCHIP bill recognize this needs to go hand in hand with efforts to assess and improve quality of care."

More information

For more on this issue, visit the National Initiative for Children's Healthcare Quality.

Posted: October 2007


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