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Wells J, Shah A, Gillis H, Gustafson S, Powell C, Krasaelap A, Hanna S, Hoefert JA, Bigelow A, Sherwin J, Lewis EC, Bline KE. Tiny patients, huge impact: a call to action. Front Public Health 2024; 12:1423736. [PMID: 38952729 PMCID: PMC11215126 DOI: 10.3389/fpubh.2024.1423736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/06/2024] [Indexed: 07/03/2024] Open
Abstract
The continuation of high-quality care is under threat for the over 70 million children in the United States. Inequities between Medicaid and Medicare payments and the current procedural-based reimbursement model have resulted in the undervaluing of pediatric medical care and lack of prioritization of children's health by institutions. The number of pediatricians, including pediatric subspecialists, and pediatric healthcare centers are declining due to mounting financial obstacles and this crucial healthcare supply is no longer able to keep up with demand. The reasons contributing to these inequities are clear and rational: Medicaid has significantly lower rates of reimbursement compared to Medicare, yet Medicaid covers almost half of children in the United States and creates the natural incentive for medical institutions to prioritize the care of adults. Additionally, certain aspects of children's healthcare are unique from adults and are not adequately covered in the current payment model. The result of decades of devaluing children's healthcare has led to a substantial decrease in the availability of services, medications, and equipment needed to provide healthcare to children across the nation. Fortunately, the solution is just as clear as the problem: we must value the healthcare of children as much as that of adults by increasing Medicaid funding to be on par with Medicare and appreciate the complexities of care beyond procedures. If these changes are not made, the high-quality care for children in the US will continue to decline and increase strain on the overall healthcare system as these children age into adulthood.
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Affiliation(s)
- Jordee Wells
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Anita Shah
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Holly Gillis
- Department of Anesthesiology, Division of Pediatric Anesthestiology, University of Minnesota, Minneapolis, MN, United States
| | - Sarah Gustafson
- Division of Pediatric Hospital Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Carmin Powell
- Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Amornluck Krasaelap
- Department of Gastroenterology and Hepatology, SeattleChildren’s Hospital, Seattle, WA, United States
| | - Samantha Hanna
- Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, United States
| | - Jennifer A. Hoefert
- Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, United States
| | - Amee Bigelow
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Jennifer Sherwin
- Division of Cardiovascular and Thoracic Surgery,Duke University Medical Center, Durham, NC, United States
| | - Emilee C. Lewis
- Division of Hospital Pediatrics, Department of Pediatrics,University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Katherine E. Bline
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
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Giunta N, Philip C, Saliba H, Rivkees SA, Nackashi J. The State of Florida, University-Based Pediatric Integrated Care System (Ped-I-Care) for Children with Special Health Care Needs. J Pediatr 2016; 170:5-6.e1. [PMID: 26922760 DOI: 10.1016/j.jpeds.2015.11.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Nancy Giunta
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL
| | | | - Heidi Saliba
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL
| | - Scott A Rivkees
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL.
| | - John Nackashi
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL
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Kaiser KL, Barry Hultquist T, Chen LW. Maternal Health-Seeking on Behalf of Low-Income Children. Public Health Nurs 2015; 33:21-31. [PMID: 26365293 DOI: 10.1111/phn.12228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Li-Wu Chen
- Department of Health Services Research and Administration; University of Nebraska Medical Center; College of Public Health; Omaha Nebraska
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Kancherla V, Van Naarden Braun K, Yeargin-Allsopp M. Dental care among young adults with intellectual disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1630-41. [PMID: 23501584 PMCID: PMC4492120 DOI: 10.1016/j.ridd.2013.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 05/07/2023]
Abstract
Dental care among young adults with intellectual disability (ID) is poorly documented and largely unmet. By using population-based data from the Metropolitan Atlanta Developmental Disabilities Follow-Up Study, we assessed factors associated with at least one or two dental visits per year among young adults with and without ID. Significantly fewer young adults with ID (45%) visited a dentist at least once per year, compared with those without ID (58%). ID severity and the presence of co-occurring developmental disabilities predicted dental care use. Sociodemographics, daily functioning, societal participation, dental services, and dental health factors were examined as predictors of dental care frequency. Our findings can help focus efforts toward improving the frequency of dental care visits among young adults with ID.
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Affiliation(s)
- Vijaya Kancherla
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kim Van Naarden Braun
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Corresponding author at: Developmental Disabilities Branch, National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention, 1600 Clifton Road MS E-86, Atlanta, GA 30333, USA. Tel.: +1 404 498 3860/908 233 8303/609 777 7715; fax: +1 404 498 3550. (K. Van Naarden Braun)
| | - Marshalyn Yeargin-Allsopp
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Gowda C, Dempsey AF. Medicaid reimbursement and the uptake of adolescent vaccines. Vaccine 2012; 30:1682-9. [PMID: 22226859 DOI: 10.1016/j.vaccine.2011.12.097] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 12/14/2011] [Accepted: 12/20/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND In light of low adolescent vaccination rates, state-level policies that could improve vaccine coverage should be evaluated. Approximately 1/3 of adolescents are eligible, primarily through Medicaid enrollment, to receive vaccines from state-administered Vaccines for Children (VFC) programs. We investigated whether Medicaid reimbursement, the scope of implementation of VFC programs (i.e. limited or universal purchase), and/or presence of school-based vaccine mandates were associated with adolescent vaccination levels. METHODS We performed a cross-sectional analysis of state-level associations between these policies and 2009 National Immunization Survey-TEEN vaccination rates for tetanus-containing, meningococcal conjugate (MCV4), and among females only, human papillomavirus (HPV) vaccines. RESULTS Medicaid reimbursement was not associated with vaccine coverage rates after adjusting for presence of vaccine-related school mandates, type of VFC program, proportion of adolescents attending preventive care visits, and state-specific distribution of insurance coverage. Participation in a more expansive VFC program (universal or universal-select) was significantly associated with HPV vaccine coverage, but not tetanus-containing vaccine or MCV4, among states that had mandates for any vaccines. CONCLUSIONS Our results suggest that, contrary to what has been shown for childhood vaccines, raising Medicaid reimbursement rates may not improve adolescent vaccine utilization. Instead, other policy changes may be more effective, such as expansion of VFC programs into universal purchase programs, further implementation of school-based vaccine mandates and efforts to raise preventive care visits among adolescents.
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Affiliation(s)
- Charitha Gowda
- Child Health Evaluation and Research Unit, University of Michigan, Department of Pediatrics, Ann Arbor, MI 48109-5456, USA
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DeVoe JE, Saultz JW, Krois L, Tillotson CJ. A medical home versus temporary housing: the importance of a stable usual source of care. Pediatrics 2009; 124:1363-71. [PMID: 19841117 PMCID: PMC3116519 DOI: 10.1542/peds.2008-3141] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Little is known about how the stability of a usual source of care (USC) affects access to care. We examined the prevalence of USC changes among low-income children and how these changes were associated with unmet health care need. METHODS We conducted a cross-sectional survey of Oregon's food stamp program in 2005. We analyzed primary data from 2681 surveys and then weighted results to 84087 families, adjusting for oversampling and nonresponse. We then ascertained the percentage of children in the Oregon population who had ever changed a USC for insurance reasons, which characteristics were associated with USC change, and how USC change was associated with unmet need. We also conducted a posthoc analysis of data from the Medical Expenditure Panel Survey to confirm similarities between the Oregon sample and a comparable national sample. RESULTS Children without a USC in the Oregon population had greater odds of reporting an unmet health care need than those with a USC. This pattern was similar in national estimates. Among the Oregon sample, 23% had changed their USC because of insurance reasons, and 10% had no current USC. Compared with children with a stable USC, children who had changed their USC had greater odds of reporting unmet medical need, unmet prescription need, delayed care, unmet dental need, and unmet counseling need. CONCLUSIONS This study highlights the importance of ensuring stability with a USC. Moving low-income children into new medical homes could disturb existing USC relationships, thereby merely creating "temporary housing."
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Affiliation(s)
- Jennifer E. DeVoe
- Department of Family Medicine, Oregon Health and Science University, 3181 Sam Jackson Park Rd, mailcode: FM, Portland, OR 97239, Phone 503-494-2826, Fax 503-494-2746
| | - John W. Saultz
- Department of Family Medicine, Oregon Health and Science University
| | - Lisa Krois
- Oregon Office for Health Policy and Research, Salem, OR
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A usual source of care: supplement or substitute for health insurance among low-income children? Med Care 2008; 46:1041-8. [PMID: 18815525 DOI: 10.1097/mlr.0b013e3181866443] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine the separate and combined effects of having health insurance and a usual source of care (USC) on access to healthcare for low-income children and to determine if one or the other is superior in ensuring better access to necessary services. METHODS We conducted cross-sectional, multivariable analyses of data from a mail-return survey of Oregon's food stamp program. Results from 2681 completed surveys were weighted back to a population of 84,087 families with adjustments for oversampling techniques and nonresponse. RESULTS Among low-income Oregon children, those with health insurance and a USC reported the best access to healthcare. In multivariable comparisons to this reference group, insured children without a USC had higher rates of unmet medical need [odds ratio (OR) = 2.18; 95% confidence interval (CI): 1.27-3.73]; no doctor visits in 12 months (OR = 6.77; 95% CI: 3.80-12.06); and problems obtaining specialty care (OR = 4.12; 95% CI: 1.59-10.68). Similarly, having a USC but not health insurance was associated with an even higher likelihood of unmet medical needs (OR = 4.33; 95% CI: 2.85-6.57); as well as unmet prescription needs (OR = 2.64, 95% CI: 1.77-3.94), and problems obtaining dental care (OR = 4.83; 95% CI: 3.31-7.06). CONCLUSIONS Incremental policy solutions are being proposed that focus on either health insurance coverage for children or expanded access to primary care. However, neither approach displaces the need for the other. The effects of a USC and health insurance, together, are additive predictors of the likelihood that children have optimal access to necessary healthcare services.
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Devoe JE, Baez A, Angier H, Krois L, Edlund C, Carney PA. Insurance + access not equal to health care: typology of barriers to health care access for low-income families. Ann Fam Med 2007; 5:511-8. [PMID: 18025488 PMCID: PMC2094032 DOI: 10.1370/afm.748] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 07/29/2007] [Accepted: 08/07/2007] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Public health insurance programs have expanded coverage for the poor, and family physicians provide essential services to these vulnerable populations. Despite these efforts, many Americans do not have access to basic medical care. This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers. METHODS A mixed methods analysis was undertaken using 722 responses to an open-ended question on a health care access survey instrument that asked low-income Oregon families, "Is there anything else you would like to tell us?" Themes were identified using immersion/crystallization techniques. Pertinent demographic attributes were used to conduct matrix coded queries. RESULTS Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs. Disproportionate reporting of these themes was most notable based on insurance status. A higher percentage of uninsured parents (87%) reported experiencing difficulties obtaining insurance coverage compared with 40% of those with insurance. Few of the uninsured expressed concerns about access to services or health care costs (19%). Access concerns were the most common among publicly insured families, and costs were more often mentioned by families with private insurance. Families made a clear distinction between insurance and access, and having one or both elements did not assure care. Our analyses uncovered a 3-part typology of barriers to health care for low-income families. CONCLUSIONS Barriers to health care can be insurmountable for low-income families, even those with insurance coverage. Patients who do not seek care in a family medicine clinic are not necessarily getting their care elsewhere.
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Affiliation(s)
- Jennifer E Devoe
- Oregon Health and Science University, Department of Family Medicine, Portland, Ore, USA
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Shankardass K, McConnell RS, Milam J, Berhane K, Tatalovich Z, Wilson JP, Jerrett M. The association between contextual socioeconomic factors and prevalent asthma in a cohort of Southern California school children. Soc Sci Med 2007; 65:1792-806. [PMID: 17658674 PMCID: PMC4098912 DOI: 10.1016/j.socscimed.2007.05.048] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Indexed: 01/31/2023]
Abstract
Spatial variation in childhood asthma and a recent increase in prevalence indicate that environmental factors play a significant role in the etiology of this important disease. Socioeconomic position (SEP) has been associated inversely and positively with childhood asthma. These contradictory results indicate a need for systematic research about SEP and asthma. Pathways have been suggested for effects of SEP on asthma at both the individual and community level. We examined the relationship of prevalent asthma to community-level indicators of SEP among 5762 children in 12 Southern California communities, using a multilevel random effects model. Estimates of community-level SEP were derived by summarizing census block group-level data using a novel method of weighting by the proportion of the block groups included in a community-specific bounding rectangle that contained 95% of local study subjects. Community characteristics included measures of male unemployment, household income, low education (i.e., no high school diploma) and poverty. There was a consistent inverse association between male unemployment and asthma across the inter-quartile range of community unemployment rates, indicating that asthma rates increase as community SEP increases. The results were robust to individual-level confounding, methods for summarizing census block group data to the community level, scale of analysis (i.e., community-level vs. neighborhood-level) and the modeling algorithm. The positive association between SEP and prevalent childhood asthma might be explained by differential access to medical care that remains unmeasured, by the hygiene hypothesis (e.g., lower SES may associate with higher protective exposures to endotoxin in early life), or by SEP acting as a proxy for unmeasured neighborhood characteristics.
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