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Health care reform needed for our children

It is a nightmare that too many parents are being forced to live today: Your child has an unexplained headache that won’t go away, or a horrible stomach ache, or difficulty breathing at recess.

Scared and slightly panicked, you call the doctor to make an appointment to find out what’s wrong—only to be told that the first available opening is 10 weeks away.

In the health industry, we call it a lack of access to pediatric subspecialty care. But it’s time we call it what it really is: a national emergency.

While adult medicine reports 36 specialists per 100,000 patients, pediatrics only has 19 specialists per 100,000 children.

That translates to long wait times: the National Association of Children’s Hospitals has found that an overwhelming majority of children’s hospitals report taking almost eight weeks to schedule gastroenterology visits, over nine weeks to schedule neurology visits, and over 11 weeks to schedule visits related to pediatric development.

So, what happens? Parents are often forced to take their children to the emergency room, where care is more expensive, less efficient, and much less likely to provide any kind of effective long-term management of a condition.

More times than not, this lack of specialty care leads them to repeatedly end up right back in the emergency room. It’s not just bad medicine, it’s bad economics, and it’s completely unsustainable for our nation.

Yet, children’s voices and concerns are largely being left out of the national debate currently raging over health care access, costs, and quality.

True health care reform will not occur unless and until the full range of care for all children—from primary care to the most specialized treatment—becomes a focal point for controlling the expensive, preventable conditions of adulthood.

Medicaid reform is the place where this conversation needs to start. Medicaid is the single largest insurer of children in the country, so its actions drive access for all children.

For all the talk about poor Medicare reimbursement levels, Medicaid pays local pediatric specialists at rates 40 percent lower than Medicare.

In many cases, the reimbursement that doctors receive for pediatric specialty care doesn’t begin to adequately address the cost of that care. And for many of these dedicated physicians, children on Medicaid make up more than half their practice, magnifying the impact of inequitable payments.

This is a primary reason why so many doctors stay away from pediatric specialty care, choosing other specialties that allow their practices to cover costs.

The health care reform bill that passed the House of Representatives’ Energy and Commerce Committee this summer includes a provision that brings fair and equitable reimbursement levels to primary care providers in the Medicaid program by phasing them in to Medicare rates. This is the correct thing to do, but it is incomplete and ineffective unless pediatric specialists are added to the provision. Congress must take note of the distinct needs of children in health reform, including that the most critical workforce shortages in pediatrics are not in primary care as they are in adult medicine.

Fortunately, Senator Sherrod Brown has recognized the crisis in the pediatric specialist workforce and the impact it is having on communities like yours. He has already incorporated pediatric workforce training measures in the Senate legislation. He is further committed to focusing the attention of Congress on the Medicaid payment problem and pediatric access to specialist care.

Now we’re urging Senator Brown’s colleagues in the U.S. House of Representatives to follow suit. Last year alone, Nationwide Children’s Hospital provided children from Congressman Charlie Wilson’s district with care more than 12,000 times, over half of it covered by Medicaid. We ask Congressman Wilson and the Ohio Congressional delegation to join with Senator Brown to assure that the promise of coverage for children under health reform means children get the care they need, when they need it.

Steve Allen, MD

Chief Executive Officer

Nationwide Children’s Hospital