On Friday, Dr. James Mandell, CEO of Children’s Hospital Boston, presented “Children are not Little Adults: A Pediatric View on Payment and Insurance Reform” at the Health Law and Policy Forum Brown Bag Lunch Series.
Through case studies, Dr. Mandell emphasized that the issues surrounding pediatric care are different than those surrounding adults. Yet, most of the thinking and analyses of health care is taken from the adult care system. The Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program is the child health component of Medicaid. While EPSDT is required in every state and is designed to improve the health of low-income children by financing appropriate and necessary pediatric services, those measures are not part of the analyses or discussion of health care reform. In many of the national health reform proposals, children are placed into so-called Exchange programs that are primarily designed for the health needs of adults. Inclusion of an EPSDT wrap is imperative in these cases.
Dr. Mandell also found that the cost drivers in pediatric care are different than those for adults. Pediatric health care spending in the United States is 13% of health care dollars. While the cost of health care for most children is relatively low, those who require hospitalization or specialty care experience a tremendous increase in total cost. While 95% of kids average barely $400 per year in health costs, there are a small number of children (1%) who need more than $30,000 in annual care.
The unique needs of children should be included in health care reform. Instead of treating children as little adults in terms of health care, children’s needs should be specifically addressed. Coverage for children should include coverage for hospitalization. Early screening and prevention should be part of the scope of benefits. Reimbursement rates should reflect the actual cost of medical procedures. Even though it is often more expensive than it would be to do the procedure on an adult, Medicaid/SCHIP currently pays 30% less for pediatric procedures. Inequity in provider payments makes it hard for kids to get the care needed for complex medical procedures. A shortage of persons who train for pediatric subspecialties limits access for children who need specialized care.
In closing, Dr. Mandell remarked that pediatric health is more of an investment rather than a cost, and one that has significant long term benefits.
-Jaspreet Chowdhary & Yelena Kuznetsov