Children with public insurance are slightly more likely to receive medical services they don't need than those with private insurance, a new study finds. In fact, one in nine publicly insured and one in 11 privately insured children received low-value care in 2014.
Writing in the journal Pediatrics, researchers evaluated data for 8.6 million children in 12 states to see whether having public or private insurance is associated with receiving low-value medical services.
While publicly insured children were a touch more likely to be on the receiving end of low-value services, the difference wasn't huge. Rather, the main takeaway was that children are very likely to receive wasteful care regardless of whether they're insured publicly or privately, meaning efforts to reduce waste should be global.
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WHAT'S THE IMPACT
The goal was to estimate the prevalence of 20 low-value diagnostic tests, imaging tests and prescription drugs, such as unnecessary vitamin D screening, imaging for acute sinus infections and antibiotic prescriptions for colds.
Among publicly and privately insured children in the sample, respectively, 11% and 9% received unnecessary services at least once in 2014 while about 4% and 3% received low-value services at least twice.
About 1 in 33 publicly and privately insured kids received a low-value diagnostic test at least once in 2014. About one in 12 publicly insured and one in 20 privately insured children received a low-value prescription drug at least once.
There are several factors that may explain why some children still receive low-value services despite evidence that they don't work. High on the list is the difficulty in changing the interventionist culture of medicine. Parents and doctors often feel that ordering a test or prescribing a drug is better than doing nothing, even though doing less is often the correct strategy.
Some interventions also stem from an overabundance of caution, with doctors afraid of missing something -- and overtreating as a result, rather than undertreating and risking something more serious.
THE LARGER TREND
Just about any medical test can turn up an incidental finding that leads to a cascade of follow-up tests. Through an October national survey of physicians, investigators found that 99% of physicians have experienced these cascades of care firsthand and report that such cascades have caused their patients psychological harm, physical harm and financial burden and have caused frustration and anxiety for physicians.
According to a 2017 Kaiser Health News report, some experts estimate that at least $200 billion is wasted annually on excessive testing and treatment. This overly aggressive care also can harm patients, generating mistakes and injuries believed to cause 30,000 deaths each year.