'Stunning' Deficiencies in Kids' Health Care

The mother of 2-year-old Kristen Todd knows what it's like to go to a pediatrician's office.

"You probably get no more than 10 minutes with the doctor," she said. "And when you have a toddler and you go in there, and they're all screaming and hollering, and the physician's running 40 minutes behind ... it's kind of a pain."

But parents like Todd may have more to worry about than inconvenience when it comes to their kids' health care.

According to a new study released Wednesday in the New England Journal of Medicine, children across the country — even those covered by health insurance — receive less than half of the health care measures that pediatricians recommend.

Study authors said that while they expected to find deficiencies, they were surprised at the extent of the problem.

"Before this study was done, most people thought kids were getting reasonably good care," said lead author Dr. Rita Mangione-Smith, associate professor at the University of Washington School of Medicine. "I have to say that, as a pediatrician, I was surprised that things were as bad as they were."

Mangione-Smith and researchers at the RAND Corp. created a set of 175 quality indicators based on national guidelines and the opinions of an expert panel of pediatricians.

The indicators cover such common childhood health care needs as preventive care, acute medical care and care for chronic medical conditions.

They then examined medical records from 1,536 children, randomly selected from 12 major metropolitan areas across the country, looking at all types of outpatient pediatric care, received from 1996 to 2000.

What they found was that children received only 46.5 percent of recommended care measures overall.

When examined by category, children received only 67.6 percent of indicated care for acute illnesses, which includes measures such as hospitalization for a severe fever.

Care for chronic medical conditions — scheduling follow-up visits after changes in asthma medication — was delivered only 53.4 percent of the time.

And the worst news came in the area of care aimed at prevention of sickness — a category that includes immunizations and routine measurements of height and weight. In this category, only 40.7 percent of the recommended care was delivered.

Public health experts not involved with the study said the results are a call to action to address the country's failure to provide high-quality health care to its children.

"It is stunning, in many ways," said Jay Wolfson, distinguished service professor in the college of public health at the University of South Florida, "to glimpse the data from this study and realize that ... the care and nurturing and investment in the health of our children may have taken a back seat to Medicaid and commercial managed care and insurance plans."

An Indictment of the Health Care System?

Study co-author Elizabeth McGlynn, associate director of RAND Health, said the structure of the American health care system may play a large role in the deficiencies.

"If you look at the incentives in the systems, and how we organize medical care ... perhaps [the results] are not surprising," she said. "In a lot of ways, we're almost doing better than what one might think we would, given all the challenges in how medical care is organized and delivered today."

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