Well-Child Checkups Rise, Sick Visits Fall Among U.S. Kids

By Lisa Rapaport

January 24, 2020

(Reuters Health) - Children in the U.S. have been getting more preventive checkups and having fewer sick visits in recent years, a new study suggests.

Researchers examined data on more than 71 million pediatric primary care visits from 2008 to 2016 for children with private health insurance. During the study period, overall visits decreased 14.4%, driven by a decline in sick visits, researchers report in JAMA Pediatrics.

"We found that overall, commercially insured children are visiting primary care offices less often than in the past," said lead study author Dr. Kristin Ray of the University of Pittsburgh and UPMC Children's Hospital of Pittsburgh.

"There was a small increase in visit rates for well-child visits, and so the decrease was due to decreased visits for specific concerns like cold symptoms, rashes and gastrointestinal symptoms," Ray said by email.

At the start of the study period, preventive checkup visit rates climbed from 74.9 to 83.4 each year for every 100 children.

Sick visit rates declined over the same time frame, from 184.7 to 144.1 each year per 100 children.

Primary care visits rates decreased for every type of diagnosis except mental health issues, the study found.

All of the kids in the study had private insurance, and it's possible that costs or access might be different for children without health benefits or with coverage through Medicaid, the U.S. health program for the poor.

While the study wasn't designed to prove whether or how any specific factors might have changed how often children see doctors, several factors may be in play, Ray said.

It's possible that more preventive checkups are getting more kids routine care and vaccines they need to stay healthy, reducing illnesses that might send kids to the doctor, Ray said.

Several new or improved vaccines were introduced during the study period that may have helped reduce sick visits and hospitalizations for conditions like pneumococcal infections, some strains of seasonal flu and rotavirus, the study team notes.

Ear infections have also become less common causes of sick visits in part because of the pneumococcal vaccine and more stringent diagnostic criteria, the researchers point out.

Increasing out-of-pocket costs like co-payments or co-insurance are making some parents less likely to take children to the doctor when they're sick, Ray added.

Out-of-pocket costs for sick visits climbed 42% during the study period, the study found.

Better communication between doctors and parents online or by phone might also be decreasing the need for children to see the pediatrician when they're sick, said Dr. James Perrin of MassGeneral Hospital for Children and Harvard Medical School in Boston.

More parents might also be realizing that they don't need to take kids to the doctor for a common cold, or that parents are taking kids to urgent care clinics instead of their regular primary care providers, Perrin, who wasn't involved in the study, said by email.

"In many communities, the growth of retail clinics, especially in suburbs, has provided a convenient alternative for parents to seeing their primary care doctor for illness care," Perrin said. "There is some possibility that the ACA support for preventive care could have led to relabeling (renaming) some acute care visits as preventive."

SOURCE: https://bit.ly/2G9aIje and https://bit.ly/2tuZu68 JAMA Pediatrics, online January 21, 2020.

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