A new study from researchers at the University of Pittsburgh and UPMC Children's Hospital of Pittsburgh shows that the number of visits to pediatricians has gone down compared to 10 years ago. However, the impact of this trend remains to be observed.
The study published in the journal JAMA Pediatrics draws attention to the change and offers some explanations for it. For instance, it could be a result of less illness, which is good. But if it is because less patients can afford a visit; it could be a major healthcare accessibility issue.
Researcher Kristin Ray says, “There's something big going on here that we need to be paying attention to. The trend is likely a combination of both positive and negative changes. For example, if families avoid bringing their kids in because of worry about high co-pays and deductibles, that's very concerning. But if this is the result of better preventive care keeping kids healthier or perhaps more physician offices providing advice over the phone to support parents caring for kids at home when they've got minor colds or stomach bugs, that's a good thing."
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The scientists looked at information from insurance claims dating from 2008 through 2016 for all patients who were 17 years or less at the time of the visit. The insurance company was a large commercial one which manages health care for millions of children across every US state, and offers multiple options to avail of its benefits. They assessed the rate of visits per 100 child years, with respect to the attributes of the child and the characteristics of the locale, as well as by the type of visit, that is, acute, or preventive, or primary care. Altogether, the data covered over 71 million visits for primary care in children, over 29 million child-years.
They found that there was a 14% decrease in the number of visits by children to their primary care doctors over the study period.
This trend is made up of two opposite movements. On the one hand, there was an 8% increase in “well child” visits for immunization and health check-ups. It is significant that this occurred during the period when co-pays for such visits were abolished by the Affordable Care Act. On the other, visits for problems like illnesses or injury went down by almost a quarter, covering almost the full range of childhood conditions except for psychiatric and behavioral issues. These, surprisingly, went up by over 40% in this time period.
The researchers interpret this trend towards fewer visits as providing fewer chances for health coaching by the pediatrician, to educate the family on health-associated behavior like immunization and healthy eating habits. However, they are on the watch for clues as to how this shift occurred, and for what reasons.
One possible cause for this change could be that there are other avenues for childcare, such as emergency care, small private clinics and telemedicine consultations to meet problems like illness and injuries. Visits to these increased during this period, but only by half of the decrease observed in visits to pediatricians.
Another explanation could be the increase in the costs of healthcare that parents have to pay out of their own pockets – which increased by 42% over this period, though the income of the average household went up by only 5% over the same time, after accounting for inflation. This is consistent with earlier research which shows that an increase in co-pays by just $1 to $10 causes the number of visits to decrease.
A third reason could be that parents just don’t have the time to visit pediatricians during office hours if they are working.
Again, many visits for diseases like ear infections are being avoided by wide immunization coverage. The recent trend towards avoiding antibiotic prescription for minor ailments like colds and coughs may have encouraged parents of children with such symptoms to treat them at home rather than bring them in for a consultation.
Children with ear infections may not be returning for review, since recent studies show this is not always mandatory. This could also cut down the number of visits.
And finally, the increasing availability of health information online could help parents decide that it’s not really necessary to visit a doctor for the symptoms their child is showing.
The researchers point out that it’s not just the children, but also adults who are generally visiting the doctor less. Senior author Ateev Mehrotra concludes: “Due to a variety of forces, Americans are not as connected with their primary care provider.” An accompanying editorial suggests that as healthcare payments move away from payment for visits to payment for increasing the health of populations, such trends are healthy.
- Ray K. N., Shi Z., Ganguli I., Rao A. Orav E. J.,Mehrotra A. Trends in pediatric primary care visits among commercially insured US children, 2008-2016. JAMA Pediatrics, January 2020. doi: 10.1001/jamapediatrics. 2019.5509. https://jamanetwork.com/journals/jama/fullarticle/10.1001/jamapediatrics.2019.5509
- Perrin, J. M., and Oreskovic, N. M. Changing pediatric primary care. JAMA Pediatrics, January 2020. doi: 10.1001/jamapediatrics.2019.5532. https://jamanetwork.com/journals/jama/fullarticle/10.1001/jamapediatrics.2019.5532