Thursday, October 18, 2007

The facts about children's health in the U. S.

My friend, Janie Metzinger of the Mental Health Association of Dallas sent this message around earlier this week. I believe it provides the factual reality facing us as we consider the cost of blocking health coverage benefits to all of our children. We need to improve the overall system of health care delivery to all of our children.

Somehow it seemed appropriate to add this post to what is below regarding the hymn heard in church on Sunday.

Please consider the facts.

BACKGROUND: A recent study published in the New England Journal of Medicine underscores concerns for children’s health raised by the President’s veto of the SCHIP legislation. (Please see The Dallas Morning News article below.)

Contrary to the rhetoric of some SCHIP opponents, the Children’s Health Insurance Program was specifically designed for children in families of middle class and moderate incomes. These families are not eligible for Medicaid, which was designed for children in very low-income families.

CHIP parents are hard-working. They often work in the construction, health care, hotel, restaurant and manufacturing industries. Many work for small businesses who simply cannot find affordable insurance to offer to their employees.

CHIP is a public-private partnership. A portion of the money for the program is put in by state governments. (Texas uses a portion of the Tobacco Settlement money for this purpose.) The state’s portion is matched by the federal appropriation, and parents pay a sliding scale premium for CHIP insurance for their children.

The state contracts the program out to private insurance carriers who vie for the business. Parents then choose which plan they want for their children. CHIP covers preventive care, lab tests, X-rays, hospital care, prescription drugs, physical therapy, rehabilitation, mental health and dental care.

Texas consistently leads the nation in the number and rate of uninsured children within our borders.

ACTION: Please contact you Senators and Members of the House of Representatives to tell them that you support CHIP. A vote may come as early as today on the veto override.

Here's the article from The Dallas Morning News from last week:

Study: Medical care for children often falls short
Doctors score low on preventive steps, tests for seriously ill infantsThursday, October 11, 2007
MELVILLE, N.Y. – Children are not faring well in the health care system, a team of researchers reports today in the largest analysis of its kind. The study, published in the New England Journal of Medicine, concludes that overall, doctors gave children the appropriate outpatient medical care only 47 percent of the time.

"They got an F," said Dr. Joseph Hagan, a Burlington, VT pediatrician. Dr. Hagan co-edited the American Academy of Pediatrics' latest update to its children's health guidelines, due out later this month.

"It's sad, but I think it reflects some unpleasant realities about our current health care system or, I might say, non-system," Dr. Hagan said.

The report, by the Seattle Children's Hospital Research Institute and the nonprofit Rand Corp. research group, is the first comprehensive look at children's health care quality. The findings are particularly troubling because nearly all the 1,536 children in the nationwide study had insurance.
Eighty-two percent were covered by private insurance. Three-quarters were white, and all lived in or near large or midsize cities.

Experts said minority children, those with more restrictive government insurance, and the millions with no insurance at all certainly fare even worse.

The compliance rate was even worse than that found in a study of adults: They got only 55 percent of recommended care.

The study was based on a review of two years of medical records of children in 12 metropolitan areas.
The new research found children's doctors did best in providing the recommended care for acute medical problems – 68 percent. They scored just 53 percent for treating chronic conditions and 41 percent for preventive care.

"I was really taken aback by the results for preventive care," said Dr. Rita Mangione-Smith, lead investigator at the Seattle institute and an associate professor at the University of Washington. "It was really kind of distressing to me that there was some really basic stuff that we should be doing that's just not happening."

The researchers found, for example, that only 19 percent of seriously ill infants with fevers taken to doctors had the correct laboratory tests to determine the underlying ailment. Only 44 percent of children with asthma, the study found, were on the right medication.

"How can we appropriately treat an infant if we don't test?" Dr. Mangione-Smith asked Wednesday.

The research also discovered babies aren't receiving routine checks of their height and weight to ensure proper growth. Some youngsters aren't receiving all of their recommended vaccinations. And children are not being appropriately screened for anemia, a marker for learning disorders.

"There can be dire consequences for the children, for their families and for society as a whole," including death, when these easily managed conditions are not controlled, said Julia Paradise of the Kaiser Family Foundation.
Some experts said the results highlight the importance of the debate over the proposed expansion of the Children's Health Insurance Program, which Congress approved and President Bush vetoed.

A vote to override the veto is set for next week. [Which, in fact, is likely today! LJ]

Ms. Paradise noted that the proposed expansion of the CHIP program was to include the first major initiative to measure and find ways to improve quality of care for children covered by that program and by Medicaid – low-income groups that generally have more health needs than others.
The study was funded by the Centers for Medicare & Medicaid Services, the Robert Wood Johnson Foundation of Plainsboro, N.J., and the California HealthCare Foundation.

The researchers noted they had incomplete medical records for some children, no children from rural areas were included, and more than half the families asked to participate didn't respond.

Dr. Mangione-Smith and the other experts said they hope the new findings will lead to action to address the shortcomings. Dr. Hagan said doctors can do more to keep up with the latest care guidelines. But he said they can't solve all the problems, such as insurance plans that don't cover crucial screenings and the inadequate time pediatricians have to spend with each child.

Basing payments to doctors on measurements of performance, as Medicare has done in some cases, should be considered, said Dr. James Perrin, a pediatrician at MassGeneral Hospital for Children.

"It's not so much training doctors as rearranging incentives to encourage people to provide high-quality care," said Dr. Perrin, co-author of an editorial in the journal on the need to improve the quality of care for children.

Another big challenge, Dr. Mangione-Smith said, is to change pediatrician training, which now focuses on treating acute illnesses in a hospital.Dr. Mangione-Smith advises parents to go to the pediatrician armed with as much information as possible.

"Come in with your own checklist," she said. "Ask your doctor, 'Is their weight OK today? Should she be checked for anemia?' "

(McClatchy Newspapers, The Seattle Times and The Associated Press contributed to this report.)


Anonymous said...

Unfortunately, the House was not able to override Emperor Bush.

Any idea what next steps will be taken. I thought I remembered some proponents saying there were other options if the bill didn't succeed.


amber lehmann said...

as a future physician, i'm near tears over the final outcome of this saga. it is difficult for me to wrap my mind around the idea that "For the cost of less than 40 days in Iraq, we can provide SCHIP coverage for 10 million children for one year." (Pelosi) and yet, we choose the former. i just don't get it.

Mr. Healthy Child said...

I didn't realize that the money to Iraq could do that much.... that is a sad thought.