Financing Childhood Health Supervision Services in the 21st Century

Abstract

Pediatricians view their communities with a unique perspective, being the only professionals who interact consistently with preschool children and their parents when providing early childhood health supervision services. This supplement, reporting the findings of the National Survey of Early Childhood Health (NSECH), is a landmark publication that improves our understanding of early childhood health supervision services. The findings indicate marked variability in health supervision visits: the topics and amount of time devoted to counseling or anticipatory guidance, the types of services, and the overall quality of the services. Although many factors influence this variability, including varying recommendations among governmental organizations and professional societies and a lack of consistent physician training, fiscal considerations also exert a powerful effect. This commentary explores how fiscal policies compromise the quality of the early childhood health supervision services and suggests financing approaches to promote the delivery of high-quality services. Currently, several fiscal policies aimed at containing health care expenditures compromise the delivery of quality pediatric health supervision services. These include family out-of-pocket expenses for health supervision services in the form of higher copayments and deductibles, excluding health supervision services from the benefits covered in the insurance plan, and reducing physician payments for pediatric services. These policies are counterproductive, increasing “downstream” expenditures while doing nothing to moderate the more powerful drivers of health care expenditures: hospital costs, pharmaceuticals, new medical technologies, and home health care. Inadequate pediatrician reimbursement in both the private and public health care sectors produces compensatory mechanisms that have an adverse impact on health …