Children in the U.S. fare worse than adults when it comes to receiving the right healthcare at the right time, according to a new study from the RAND Corp., Seattle Childrens Hospital Research Institute and the University of Washington School of Medicine.
In the study, The Quality of Ambulatory Care Delivered to Children in the United States, which assessed 175 measures of quality covering 12 clinical areas, researchers analyzed the records of more than 1,500 children selected randomly from 12 metropolitan areas. Parents provided written informed consent, and nearly all of the children had some form of health insurance, including 82% who had private coverage.
The study assessed the extent to which care that is recommended for children is actually delivered. Results showed that, on average, children received about 47% of the indicated care. In addition, children received about 68% of recommended care for acute medical problems; 53% of recommended care for chronic medical conditions; and about 41% of recommended preventive care. Appropriate preventive care includes screening services, such as regular weight and measurement checks to ensure kids are growing properly and not at risk for obesity.
Elizabeth McGlynn, associate director at RAND Health in Santa Monica, Calif., and one of the studys authors, said the nations reimbursement system has perverse incentives, given that physicians are reimbursed for quantity, not quality.
We need to seriously invest the time, energy and money to find out how to do a better job, McGlynn said. That starts with measurement. We dont routinely measure how were doing. We have to make that information publicly available. If you report it publicly, you have a chance to learn from those who are doing it well, she said, adding that other factors include evaluating the payment system and also how physicians are trained. In the meantime, McGlynn explained, parents should advocate effectively for their children.
The study will appear in the Oct. 11 issue of the New England Journal of Medicine. -- by Jessica Zigmond
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