Posted on 07/02/2024 4:39:59 PM PDT by nickcarraway
The health of future generations is at stake
The summer heat wave blazing across the U.S. is set to endanger millions of infants and childrenopens in a new tab or window, who are physiologically more vulnerable than adults to its impact. Unfortunately for American families, access to pediatric care is quickly evaporating from the healthcare landscape.
A variety of factors are exacerbating this problem, ranging from decreasing interest in pediatrics as a specialty to the closure of pediatric hospitals across the country. But no matter the cause, the picture is bleak.
The Landscape of Pediatric Care
Pediatric hospitals have been disappearing all across the country. During the decade before the COVID pandemic, data from the American Hospital Association survey showed an average of 407 pediatric inpatient bedsopens in a new tab or window were lost every year -- either due to the closing of entire pediatric units or due to the redistribution of resources to more lucrative adult and subspecialty care units.
It wasn't because there were significantly fewer children to fill these beds; in fact, the U.S. pediatric population decreased by less than 1%opens in a new tab or window in this same period. Comparatively, in rural America where the stark decline in access has been even more drastic, pediatric inpatient capacity decreased by 26.1% between 2008 and 2018.
After the pandemic, children's hospitals across the U.S. only struggled more, and a few pediatric medical centers -- including the former Tufts Floating Hospital for Childrenopens in a new tab or window -- had to close down completely.
Most disconcerting, access to emergency and critical pediatric care has also become increasingly limited. Though children account for roughly a quarteropens in a new tab or window of all emergency department (ED) visits in the U.S., 85% of childrenopens in a new tab or window are seen in non-pediatric EDs.
While not every emergency department needs to sub-specialize in pediatrics, they do need to be able to stabilize a patient of any age. Unfortunately, on the most recent assessment by the National Pediatric Readiness Project -- a program that regularly evaluates how prepared EDs across the nation are to care for children -- the median score was 69.5/100opens in a new tab or window.
In contrast, Pediatric Intensive Care Units (PICUs) provide highly specialized medical care to just children. While the overall number of PICU beds may have increased recently, the actual number of hospitals able to provide PICU-level care has declined.
Pediatric critical care is now nearly exclusively located in large academic medical centers -- 63 hospitalsopens in a new tab or window in the nation account for about half of all the PICU beds. In the past few years, pediatric critical care has only continued to consolidate, requiring families outside of these hubs to travel further and further for desperately necessary services.
What's Driving This Access Crisis?
Ultimately, the reason why access to pediatric care is disappearing is because the medical field has been systematically undervaluing care for children for years.
Across general practice and subspecialties, adult care providers have, on average, a $1.2 million higheropens in a new tab or window lifetime earning potential compared to their pediatric counterparts.
Adult and pediatric residency programs also receive vastly different amounts of governmental support. An adult medicine program may receive nearly twice as muchopens in a new tab or window per-resident funding from Medicare as a freestanding children's hospital does from Children's Hospitals Graduate Medical Education (CHGME) -- whose budget, unlike Medicare, is set by annual congressional approval.
Meanwhile, the number of applicants to U.S. pediatric residencies has fallen for the ninth straight year. A total of 252 positionsopens in a new tab or window across more than 60 pediatric programs went unfilled during this year's residency match.
Even accounting for the overall increase in primary care residency spots in 2024, this discrepancy means that fewer physicians are going into pediatrics compared to last year. Moreover, trainees are not shifting their interest to other programs that can care for children; family medicine finished Match Day with 12% of its available training positions unfilledopens in a new tab or window.
Reimbursements play a role too: the pediatric population is proportionally much more dependent on Medicaid, which reimburses inpatient care at a 22% lower rateopens in a new tab or window than Medicare does (and a much lower rate than private insurers.)
Even when procedures and admissions have similar complexity, many state Medicaid/CHIP programs still reimburse pediatric care at lower rates. Many of the best pediatric hospitals in the U.S. still depend upon donors, grants, and philanthropic partnerships in order to keep their doors open.
Healthcare in America is expensive and hospitals have an impossible task trying to stay in the black. But with infant mortality, adolescent suicidality, and childhood chronic diseases all on the rise, pediatrics is not the place to cut corners.
Yet policymakers keep doing just that. Earlier this spring, Congress approved an $8 billionopens in a new tab or window cut in the yearly budget for Medicaid Disproportionate Share Hospital payments, a program many children's hospitals depend on to support lower-income families.
A judge recently dismissed Florida's suit against CMS to disenroll children from its CHIP program for nonpayment of premiums, though the state is likely to seek an appeal. Meanwhile, over 22,000 Florida childrenopens in a new tab or window have already been disenrolled due to unpaid premiums so far this year -- a dangerous precedent that could open the door to the disenfranchisement of millions of American children.
The Health of Future Generations
The health of the next generation and the future health of this nation is in peril. It's time to get serious about investing in the well-being of children.
Policymakers, healthcare administrators, educators, providers, and families need to oppose legislation that discounts the importance of pediatric care for all children. State and federal payment programs need to be restructured in order to stop short-changing children's hospitals and their doctors.
Truthfully, healthcare for children is never going to be profitable in the short term. But it is worth the cost because, in the long term, the U.S. cannot afford to keep getting sicker.
Kristen Sparagna, MD,opens in a new tab or window is a fellow with Massachusetts General Hospital Rural Health Fellowship and The OpEd Project Public Voices Fellowship.
Right on time with Biden’s heat initiative.
“Access to Pediatric Care Is Rapidly Eroding”
Considering that they’re almost as bad as Librarians, is losing access to them such a bad thing?
millions of illegal alien border jumpers kids who get priority treatment while not paying a dime and bankrupting medicare have anything to do with it ?
I say let’s beat the snot out of Librarians. Are you with me BobL? Now what is it they did again?
“I say let’s beat the snot out of Librarians.”
Just closing the libraries would be sufficient for me.
Oh, okay. No book burnings?
“Oh, okay. No book burnings?”
I’m not a book burner, but I do oppose pornography directed at children, and those that push it.
Read later. At least article ain’t complaining about shutdown of ‘gender-affirming care.’
AAhhhh, now I see. It makes sense now. Carry on.
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