Kids with public insurance are slightly more likely to receive medical care that they don’t need than those with private insurance, a new study finds.
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 we found that publicly insured children were a little more likely to receive low-value services, the difference was not large. The more important finding is that children are highly likely to receive wasteful care regardless of what type of insurance they have. This means that efforts to reduce waste should be global in nature and target the care of all children.”
Researchers estimated 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 percent and 9 percent received unnecessary services at least once in 2014 while about 4 percent and 3 percent received low-value services at least twice.
About one 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.
“Our study shows that insurance type doesn’t strongly predict whether a child is likely to receive wasteful care,” said Chua, who’s also a researcher at the University of Michigan Institute for Healthcare Policy and Innovation.
Chua points to 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.
“The expectation that something be done can be particularly high when parents miss work and children miss school to go to the doctor, or when children previously received an unnecessary intervention for the same condition, like an antibiotic for a cold.”
Some interventions also stem from an overabundance of caution.
“Doctors have a strong fear of missing something,” Chua said. “Some doctors would rather over-treat and risk the side effects of the intervention than under-treat and risk missing a catastrophic problem.”
All low-value services also come with wasteful health care spending, Chua said.
“These interventions waste health care dollars that could be devoted to other valuable causes, and also force many families to pay out-of-pocket for unnecessary care,” Chua said. “Reducing wasteful care will improve child health and decrease the financial burden of health care spending on society and families.”