Study shows 14% decline in pediatrician visits
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Pediatric primary care visits among commercially insured children declined by more than 14% over a recent 9-year period, according to study findings published in JAMA Pediatrics.
“Two factors that we looked at within this study were increasing costs to families and increasing visits to other sites,” Kristin Ray, MD, MS, assistant professor of pediatrics at the University of Pittsburgh School of Medicine, told Healio. “We found evidence suggesting both of these factors may be contributing, but neither seem to completely explain what we found, suggesting additional factors may be involved.”
Ray and colleagues observed claims data from 2008 through 2016 for children aged 17 years or younger who were covered by large national commercial health insurance companies to determine visit rates per 100 child-years and assess other trends. To avoid any extreme outliers, they did not include any child-years with more than 100 primary care visits in a single year.
According to the analysis, pediatric primary care visits decreased by 14.4% over the course of the study (95% CI, –15% to –13.9%). Meanwhile, preventive care visits increased by 9.9% (95% CI, 9% to 10.9%). This change occurred during the span when the Affordable Care Act eliminated copays for these types of visits.
“Also, some quality metrics during this time period focused on the number of well-child visits children received, encouraging physicians to make sure children receive these visits,” Ray said. “Both of these factors may be contributing to the increase in well visits.”
The researchers observed a 24.1% decrease in problem-based visits (95% CI, –24.6% to –23.5%). Only psychiatric and behavioral health visits increased, growing by 42% (95% CI, 36.8% to 47.3%).
“This means that children and their families are visiting their pediatrician less throughout the year, presumably resulting in fewer opportunities for the pediatrician to connect with families on preventive care and healthy behaviors, like vaccinations and good nutrition,” Ray said in a news release.
Children may be receiving care elsewhere. According to Ray and colleagues, visits to EDs, urgent care, retail-based clinics and telemedicine consults increased by more than 30% during the study period.
Ray said another reason could be due to higher out-of-pocket costs. During the study, out-of-pocket costs for problem-based primary care visits increased by 42%, according to the study. At the same time, inflation-adjusted median household income increased by only 5%.
The researchers noted that children with common illnesses such as ear infections or UTIs do not always need to return for follow-up visits, which could lead to fewer pediatric visits.
Ray said she was surprised to see a decrease in problem-based visit rates across a wide range of diagnoses, not just ear infections. – by Ken Downey Jr. and Eamon Dreisbach
Disclosures: Ray reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Sharon Nachman, MD
There are several reasons that pediatrician visits being on the decline is worrisome:
- As the authors mention, the increasing cost of copays may have some families thinking twice about visiting a doctor's office, especially when a child is well. Often parents who are on a tight budget will put off well visits, thinking that being well translates into no need to see their child’s health care provider;
- The next issue to indicate is the loss of a relationship between a child’s primary care doctor and the family. With so many “experts” and health websites telling families what is normal, what’s not and — most importantly — what to do, families less often are asking the real expert their questions;
- If these families have less of a relationship with their child doctor, then when their child is ill, they will simply go to a walk-in center for a “quick diagnosis,” leading to missed opportunities to ask open-ended questions about their child, that address the bigger picture of their child‘s health and development;
- More families have two working parents (or a single parent juggling more than one job), leaving little time to schedule a well visit, which often happens in the middle of the day with its associated loss of money for the working parent.
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