How to help your child avoid unnecessary medical care
If your child has ever put up a fight when you try to give them medicine, you may have wondered if that antibiotic was really, absolutely necessary. You'd be right to wonder: Many children receive "low-value services" — defined as "health-care interventions that are more expensive and equally or less effective than an alternative, including doing nothing," according to the authors of a recent study in Pediatrics.
Researchers listed and analyzed how frequently doctors prescribed 20 low-value pediatric services, including imaging procedures for sinus infections, and oral antibiotics for colds. They discovered that one in nine publicly insured and one in 11 privately insured children received such unneeded health-care services in 2014.
It's important to note that the services named in the study aren't low-value for all pediatric patients; indeed, these services are high-value for specific groups of children with specific health issues. But the problem is that these services are being used more widely than they should, and in many cases, they're unnecessary and costly.
Low-value services are common for several reasons, says study lead author Kao-Ping Chua, MD, Ph.D., a pediatrician, researcher, and assistant professor of pediatrics at the Susan B. Meister Child Health Evaluation and Research Center at the University of Michigan Medical School. "In some cases, the doctor may not be aware that a service is low-value," he points out.
"In other cases, it's a social issue: Parents understandably want their child's suffering to be alleviated, and doctors understandably want to help," Dr. Chua continues. "Sometimes doctors will feel like parents will be dissatisfied if they recommend observation, prompting them to order an intervention." But it's important to note that parents aren't the sole drivers of unnecessary medical care: Certain low-value services are common among adults, too.
Low-value tests and treatments can be dangerous. Taking unneeded antibiotics can lead to antibiotic resistance. Every year, more than 35,000 people in the U.S. die from antibiotic-resistant infections, according to the Centers for Disease Control and Prevention. Low-value treatments are also expensive: A 2013 Institute of Medicine report estimated that unnecessary medical services added an extra $210 billion to health-care costs in 2009 alone.
So, what can you do if you think your child might be receiving unnecessary and low-value treatment?
1. Get informed. "Parents should feel empowered to ask questions," Dr. Chua says. While "doctors often have so little time to talk with patients that they may feel pressured to write an antibiotic prescription for what's likely a viral illness just because it lets them get to their next patient faster," don't hesitate to voice your concerns. The Choosing Wisely initiative, from the American Board of Internal Medicine Foundation, has advice on what to ask a doctor before any test, treatment, or procedure. In addition, the non-profit think tank Lown Institute has answers to commonly asked questions about medical over-treatment.
2. Trust your doctor. "The vast majority of pediatricians are doing their best to deliver high-value care," Dr. Chua asserts. "It is absolutely true that there are enormous gaps in the quality of health care in the U.S., whether in pediatrics or in adult medicine. But these gaps are only partially the responsibility of doctors. The system is not designed to promote the practice of parsimonious [effective, efficient, and responsible], high-value care." In other words, your child's pediatrician just wants your kid to be healthy.
3. Consider waiting. "Parents should ask about the risks and benefits of interventions," says Dr. Chua. "If they aren't comfortable with an intervention, they should ask whether it would be reasonable to wait. Sometimes just asking that question can get a doctor to re-think the course of action."
Has unnecessary medical care declined in recent years? Well, yes and no: "I think that some of the services may have become slightly less common over time," notes Dr. Chua, citing increased awareness of such procedures and treatments. "That said, it's really hard to change how clinicians practice." Chua's own study of more recent data showed that 11 percent of privately insured children received unnecessary antibiotics in 2016. So, "clearly there is still a lot of work that needs to be done."
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