You stand a better chance of getting heads in a coin flip than U.S. children have of receiving high-quality healthcarethat is, the right care, delivered when they need it.
Kids care reflects badly on U.S.
This stunning news about the state of childrens healthcare, published last week in the New England Journal of Medicine, comes hard on the heels of President Bushs veto of the bipartisan State Childrens Health Insurance Program. The SCHIP debate has focused national attention on kids healthcare coverage. More than 9 million American children live each day without any health insurance coveragewhich virtually guarantees that theyre not getting the care they need.
But the new study should put America on notice that the healthcare debate cannot stop at cost and coverage.
The New England Journal study, conducted by the RAND Corp., Seattle Childrens Hospital and the University of Washington School of Medicine, and supported by the Robert Wood Johnson Foundation, is part of a groundbreaking effort to show whats happening with our healthcare in America. For this latest study, researchers examined 175 quality measures for things like screening, diagnosis, treatment and follow-up care for common childrens health issues.
They reviewed the medical records of 1,500 children. They found that, on average, children received only 46.5% of the indicated care. By comparison, a similar study of adults found they received recommended care 54.9% of the timebetter, but not by much. These percentages are deplorable for a country that spends more on healthcare per capita than any other nation.
What are these new data telling us? First, while healthcare coverage for children is vital, it is not enough. In the new study, nearly all of the children in the analysis had coverage, and more than 8 in 10 had private insuranceand they still received poor-quality care.
Second, were better at treating acute medical problems than managing chronic disease.
Third, some of our most pressing public health battles arent being fought on the front lines. Consider obesity: More than 33% of all children and adolescents are overweight or obese. Yet according to this study, only 31% of 3- to 6-year-olds, and 15% of adolescents, have their weight monitored, a critical step to forestalling later problems such as hypertension and diabetes.
Finally, the new data reaffirm something weve always known about healthcare: You get what you pay for. We have a system that has traditionally paid providers for doing things and showing upperforming procedures or conducting tests and conducting visitsbut not necessarily for doing the right things, such as helping prevent or manage diabetes, asthma and other chronic illnesses.
Risa Lavizzo-MoureyPresident and chief executive officer Robert Wood Johnson Foundation Princeton, N.J.
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