Tuesday, May 6, 2008

Health Care and Children

The American Academy of Pediatrics advocates that all children should have access to comprehensive, age-appropriate, quality health care. They advocate that all newborns, infants, children, adolescents, young adult patients through age 21 years, and pregnant women must have access to comprehensive health care benefits that will ensure their optimal health and well-being. The AAP wants medical services to be included in the health benefit plans offered by all private and public insurers. These services should be delivered by appropriately trained and board eligible/certified pediatric providers, including primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists. All providers of prenatal care should be able to identify a full range of medical and psychosocial risks and to refer patients for appropriate care throughout pregnancy. These services should be delivered in a variety of appropriate settings, and coordinated through the child's medical home, and they also should be delivered in an efficient manner that does not compromise the quality of care.

As a matter of fact, the AAP laundry list of services they want available to all children is very extensive and includes the following:

1.) Medical care including: a) health supervision with preventive care and immunizations according to the American Academy of Pediatrics' "Recommendations for Preventive Pediatric Health Care," and b) diagnosis and treatment of acute and chronic illness, developmental disabilities, learning disorders, and behavioral problems.
2.) Surgical care.
3.) Mental health, substance abuse, and services for other psychosocial problems including therapy, crisis management, day treatment, and residential care. This should also include evaluations and treatment of learning disabilities and related disorders such as attention deficit hyperactivity disorder.
4.) Emergency medical and trauma care services for children.
5.) Inpatient hospital and critical care services.
6.) Pediatric critical care, pediatric medical subspecialty, and pediatric surgical specialty consultations occurring either in the inpatient or outpatient setting.
7.) Family planning services.
8.) Pregnancy services including: a) genetic counseling and related services as needed; b) prenatal care; c) prenatal consultation with a pediatrician or board eligible/certified provider of pediatric care; d) care for all complications; e) counseling and services for all pregnancy management options; and f) care for the pregnancy of a dependent of a policyholder.
9.) Care of all newborn infants including: a) attendance at and management of high-risk deliveries or those mandated by hospital regulations; b) health supervision; c) treatment of congenital anomalies and other medical and surgical conditions; d) newborn intensive care services; and e) when indicated by the infant's physician, a follow-up visit in the child's home or in the physician's office within 48 hours of discharge.
10.) Laboratory and pathology services including screening for metabolic and other congenital disorders.
11.) Diagnostic and therapeutic radiology services.
12.) Anesthesia services including anesthesia when appropriate for all "covered" procedures.
Early intervention services and therapies for developmental, rehabilitative, and habilitative purposes including, but not limited to: a) physical therapy; b) speech therapy and language services; c) occupational therapy; and d) audiology.
13.) Home health care services including, but not limited to, private duty nursing, attendant care, and respite care.
14.) Intermediate or skilled nursing facility care in lieu of hospital care.
15.) Hospice care.
16.) Case management and care coordination integrated with child's primary care provider and family as required by those with special health care needs.
17.) Medical and social services required to evaluate and treat suspected child physical and sexual abuse in both inpatient and outpatient settings.
18.) Transfer/transport to a hospital or health facility.
19.) Preventive and restorative dental care and oral surgery.
20.) Nutritional and lactation counseling services.
21.) Prescription drugs, medical and surgical supplies, and special nutritional supplements, including, but not limited to, those prescribed under national clinical trials for acquired immunodeficiency syndrome/human immunodeficiency virus and other conditions.
22.) Rental or purchase and service of durable medical equipment including, but not limited to, equipment necessary to administer aerosolized medication and to monitor their effects, corrective eyeglasses or lenses, hearing aids, breast pumps, prostheses/braces, electrical and other types of ventilators, cardiorespirator monitors, oxygen concentrators, and customized wheelchairs.

Wow! That's a huge amount of medical care and treatment options for kids. Unfortunately, there is no perfect insurance coverage or medical plan on the market that includes all these items. If there was one that was all inclusive, it would cost an absolute fortune. Parents do their best to provide health care for children from the pre-natal stage through college, and the cost to do that is astronomical in the current market. Unfortunately, there are more than 9 million children lack health insurance, and millions more have inadequate coverage in the wealthiest nations in the world. Providing health coverage for all children should be a national priority. Investing in children's health yields many benefits, including improved development, improved school performance, and long-term savings in health care costs according to the Campaign for Children's Health Care.

Children need access to health care, and they should also be seen by a primary physician for regular checkups and ongoing medical needs. Nothing takes the place of a consultation with a physician, a health history, a physical exam, and a two-way conversation with time for questions and answers. The Nemours Foundation has many tips for pediatric health. Learning about health isn't just about medical diseases and conditions. It's also learning about the amazing ways the body works — and how to keep it working in the best way possible. It's about normal physical development and stages — and how they can differ from person to person. It's about the emotions and worries almost everyone faces — and how to keep things balanced. It's about stress that can interfere with daily life — and what to do to get some help. It's about thinking ahead so you can do the things you need to stay healthy — and how to prevent the things that can cause serious problems later on. It's about how families function in the good times — and in the bad. It's about the joys and challenges of parenting — and what families can do to help their kids and teens travel along the path that's best for them.

The Associated Press reports that over 200 million children worldwide do not have access to basic health care. As a result, about 10 million children, most from the developing world, die each year from treatable illnesses. An alarming number of countries are failing to provide the most basic health services that would save lives, with 30% of children in developing countries not getting basic health intervention such as prenatal care, skilled assistance during birth, immunizations and treatment for diarrhea and pneumonia. Wide disparities in health care for the poorest and best-off children are seen even in the highest-ranked countries. Use of existing, low-cost tools and knowledge could save more than 6 million of the 9.7 million children who die every year from easily preventable or curable causes, said the report issued by Save the Children. Some treatments include antibiotics that cost less than $0.30 to treat pneumonia, the top killer of children under 5, and oral rehydration therapy—a simple solution of salt, sugar and potassium—for diarrhea, the second top killer.

The United States has one of the best health care systems in the world. Yet, there is still room for improvement, especially for treating children and providing coverage for special and catastrophic health care needs. In addition to improving the status of uninsured children in out country, there needs to be a focused effort to help developing countries set up sustainable primary care networks in socially and economically disadvantaged areas. Much of this work is supported by private donations from foundations, corporations, charitable organizations, and individuals. The disadvantage is that many developing countries have no infrastructure to support health care, and many more governments are not interested in focusing resources to manage the health care and medical needs of their respective populations--especially children. In addition, there are some countries that have cultural mandates that disallow anyone in certain ethnic or caste demographics to even have access to health care.

Although the U.S. has a huge problem with about 16% of the population being uninsured, it could be worse. What our faith-based organizations, private corporations and employers, insurance companies, the medical community, and the government need to do is to more effectively manage the costs of medical treatment and to step up coordination of efforts on local, regional, and a national level to reign in the upward spiral of health care expenses. There are ways to manage costs more efficiently and decrease unnecessary expenses. Universal health care is not the answer; the net result would be government control of our health care system and a huge tax burden on the American taxpayer. Less money in the pocket means less health care for families and children.

Until next time. Let me know what you think.

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