Why Are Fewer U.S. Kids Going to Pediatricians?
Little Johnny's cough has lasted for days, leaving Mom and Dad wondering if the symptoms warrant a trip to the doctor. A new study suggests that such parents may choose to skip that standard pediatric sick visit.
Overall visits to the pediatrician in the United States dropped by 14% between 2008 and 2016. Sick visits were down 24%.
At the same time, well-child visits seemed to buck the trend -- they actually increased by 10%.
The researchers pointed to several possible reasons for the change, including increasing out-of-pocket costs, the availability of urgent care clinics, and maybe even healthier kids.
"I think there may be different things going on, and we have to support the positive changes like the small increase in preventive visits," said study lead author Dr. Kristin Ray. She's an assistant professor of pediatrics at the University of Pittsburgh School of Medicine.
"And, are there ways we can zero in on the negative reasons to create a more ideal system of care -- one with health care that's affordable, accessible and available when families need it," Ray said.
Since the Affordable Care Act's debut in 2010, there have been major shifts in primary care. Many preventive services, including well-child visits, are covered fully. That means parents have no out-of-pocket costs for preventive care.
For sick visits, however, costs have often gone up. Deductibles, co-pays and co-insurance may leave families paying more out of pocket.
There are also more options for care, researchers noted. If a child complains of a sore throat at 8 p.m., parents can visit an urgent care clinic instead of waiting until the next day to see their child's pediatrician.
The study included U.S. insurance claims data from 2008 through 2016 for children 17 years old and younger. The data came from a commercial insurance plan that covers millions of kids in all 50 states.
Researchers found a decrease in overall pediatric primary care visits for all groups of children. The decrease was smallest for those 1 year and younger. More people had to shoulder a deductible for problem-based pediatric visits over the study period. For many, out-of-pocket costs for these visits rose.
Parents did seek alternatives to the standard pediatrician sick visit, including treatment at urgent care and retail clinics as well as telemedicine consults. These visits accounted for about half of the decrease in pediatric sick visits, the study found.
Vaccinations may also have reduced the need for some sick visits. And, because many doctors are less likely to prescribe antibiotics for cold symptoms, parents might be waiting longer to see a pediatrician, researchers theorized.
The findings were published Jan. 21 in JAMA Pediatrics.
Dr. James Perrin co-authored an editorial accompanying the study. He said it's hard to say whether the changes in pediatric visits are good or bad.
"These changes fit with other patterns we're seeing in well-child and care patterns in general. Consumers are increasingly knowledgeable in the context of pediatric care, and know that many things don't need an actual visit with the doctor," said Perrin, a pediatrician at MassGeneral Hospital for Children in Boston.
"There are many different ways of communicating with your child's doctor now. There's more phone call management," he said.
Perrin added that less traditional ways of getting care -- phone calls, telemedicine, urgent care clinics -- are very helpful for young parents. "Finding time to show up at the doctor's office is very difficult for young families where both parents work."
Still, he recommended having a medical home for your kids.
"My sense is that the Affordable Care Act did a number of really good and important things. Preventive care is essentially free, and it allows pediatricians and their office team to spend more time on preventive care, and to think more holistically about children's health. Parents should make use of their preventive care benefits," Perrin said.
Learn more about choosing a pediatrician from the American Academy of Pediatrics.
SOURCES: Kristin Ray, M.D., M.S., assistant professor, pediatrics, University of Pittsburgh School of Medicine; James Perrin, M.D., pediatrician, MassGeneral Hospital for Children, and professor, pediatrics, Harvard Medical School, Boston; JAMA Pediatrics, Jan. 21, 2020