Health Care for U.S. Kids Falls Short

A new study reveals surprising statistics concerning
the quality of medical care for children.
The shocker: Most of those studied had insurance

by Catherine Arnst

More evidence that the U.S. health-care system is far from stellar: It seems that even white, middle-class, well-insured children get poor quality health care more often than not. A large study published in the New England Journal of Medicine found that American children receive recommended health-care procedures only 46% of the time when they see a doctor. In fact, children get even worse care than adults, who receive appropriate care about half the time, according to a similar survey published in 2003.

“Taken together, these studies show that no one, anywhere, is immune from poor quality of care [in the U.S.],” says lead researcher Rita Mangione-Smith of Seattle Children’s Hospital Research Institute.

The researchers, from the
Rand Corp. and University of Washington as well as Seattle Children’s, reviewed the medical records of 1,536 children from 12 metropolitan areas around the country and assessed 175 measures of quality in 12 clinical areas. They found that children in the U.S. do not routinely receive regular weight and measurement checks, widely recommended screening tests, or standard care for asthma and diarrhea. “As a pediatrician, I was shocked by some of our findings,” says Mangione-Smith. “I rescreened several of the charts because I couldn’t believe the results we were getting.”

The children in the study were predominantly from white, middle- or upper-middle-class families; 82% were covered by private insurance. Children without insurance likely fare far worse, the researchers noted.

The study, published in the Oct. 11 issue of the journal, comes a week after President Bush vetoed a bill that would have expanded the State Children’s Health Insurance Plan (SCHIP). Charles Homer, a pediatrics professor at Harvard Medical School, points out that the bill would also have funded federal initiatives to improve quality of care. “If SCHIP were implemented, and quality initiatives were put in place. I believe private insurers would have followed its lead,” says Homer. “In general, getting more kids insured is a good thing for their quality of care. That’s a no-brainer.”

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