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By Serena Gordon
HealthDay Reporter

TUESDAY, January 21, 2020 (HealthDay News) – Little Johnny's cough has lasted for days, leaving mom and dad wondering if the symptoms warrant a trip to the doctor. A new study suggests that such parents may choose to skip that standard pediatric visit due to illness.

General visits to the pediatrician in the United States decreased by 14% between 2008 and 2016. Sick visits decreased by 24%.

At the same time, visits by healthy children seemed to counteract the trend: they actually increased by 10%.

The researchers pointed out several possible reasons for the change, including increased out-of-pocket costs, the availability of urgent care clinics and perhaps even healthier children.

"I think different things may be happening, and we have to support positive changes such as the small increase in preventive visits," said lead author of the study, Dr. Kristin Ray. She is an assistant professor of pediatrics at the University of Pittsburgh School of Medicine.

"And, are there ways we can focus on the negative reasons for creating a more ideal care system, one with medical care that is affordable, accessible and available when families need it," Ray said.

Since the debut of the Low Price Health Care Act in 2010, there have been major changes in primary care. Many preventive services, including healthy child visits, are fully covered. That means parents have no out-of-pocket costs for preventive care.

However, for sick visits, costs have often increased. Deductibles, copays and coinsurance can leave families paying more out of pocket.

There are also more care options, the researchers noted. If a child complains of a sore throat at 8 p.m., parents can visit an urgent care clinic instead of waiting until the next day to see their child's pediatrician.

The study included data on US insurance claims. UU. From 2008 to 2016 for children 17 years and under. The data comes from a commercial insurance plan that covers millions of children in all 50 states.

The researchers found a decrease in general pediatric primary care visits for all groups of children. The decrease was smaller for those of 1 year and less. More people had to assume a deductible for pediatric visits based on problems during the study period. For many, out-of-pocket costs for these visits increased.


Parents sought alternatives to the standard visit for pediatric disease, including treatment in urgent care and retail clinics, as well as telemedicine consultations. The study found that these visits accounted for approximately half of the decrease in visits due to pediatric disease.

Vaccines may also have reduced the need for some sick visits. And, since many doctors are less likely to prescribe antibiotics for cold symptoms, parents may be waiting longer to see a pediatrician, according to the researchers.

The findings were published on January 21 in JAMA Pediatrics.

Dr. James Perrin was co-author of an editorial accompanying the study. He said it is difficult to say if the changes in pediatric visits are good or bad.

"These changes are in line with other patterns we are seeing in healthy childcare patterns in general. Consumers are increasingly informed in the context of pediatric care and know that many things do not need a real visit to the doctor," said Perrin, a pediatrician at MassGeneral Children's Hospital in Boston.

"There are many different ways to communicate with your child's doctor now. There is more phone call management," he said.

Perrin added that less traditional ways of receiving care (phone calls, telemedicine, urgent care clinics) are very useful for young parents. "Finding time to show up at the doctor's office is very difficult for young families where both parents work."

Still, he recommended having a medical home for his children.

"I have a feeling that the Low Price Health Care Act did a number of really good and important things. Preventive care is essentially free and allows pediatricians and their office team to spend more time on preventive care and think more comprehensively about children's health. " Parents should make use of their preventive care benefits, "Perrin said.

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SOURCES: Kristin Ray, M.D., M.S., assistant professor, pediatrics, University of Pittsburgh School of Medicine; James Perrin, M.D., pediatrician, MassGeneral Hospital for Children, and professor, pediatrics, Harvard Medical School, Boston;JAMA PediatricsJanuary 21, 2020

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