Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: Paying for Pediatric Care

Category: Access To Children's Health Care


The American Academy of Pediatrics has set a goal to provide good medical care for all children in our society. This is a very challenging goal in that approximately 1/3 of the children, due to poverty and other reasons do not receive adequate health care at this time. The American Academy of Pediatrics has worked out a five year plan to provide better funding and availability of care to all children in the country.

The basic proposal by AAP is to provide health insurance to all children up to age 21 and to pregnant women. This would be funded by the present medicaid money being received by each state in addition to a tax of 3.5 percent to all employers throughout the country who do not provide insurance for their employees. In addition to this, individual families could receive a basic medical care policy which would cost them differing amounts on a sliding scale according to their income level. This would provide them with the equivalent of a medicaid card which is available now to the most indigent population. The biggest group being under-served today are the working poor who do not receive insurance from their employers and who do not qualify for medicaid cards and who can not afford the high cost of most medical insurance plans.

One of the concerns about this plan is that insurance companies won't want to get involved. Dr. Donald Schiff, the outgoing president of the American Academy of Pediatrics, feels confident that they will because of the approximate 100 billion dollars involved. Another concern is how the plan will cover high cost patients such as an infant born with AIDS. This has been all worked out mathematically by the committees who have worked on this for the past few years and they feel that even catastrophic illnesses such as AIDS and severely ill prematures and childhood cancers, chronic childhood diseases such as heart disease, kidney disease and so many other potentially expensive patients would be covered by the catastrophic protection indexed into the plan. They feel that they have this worked out and that it would be adequately covered.

No matter what plan the AAP works out and is able to get through Congress, it is clear to me that in Louisiana we should better support our poor, uninsured children and pregnant women. The amount of money invested in providing good prenatal care, good care given at the time of delivery and good preventive medical care, good routine checkups and immunizations to small children is very small in comparison to the cost of paying for our chronic ill and dependent individuals who were not cared for properly to start with. One problem that exist throughout Louisiana has been not only funding of these individuals but finding doctors who will take care of them. We have a charity hospital system in place which has grown inefficient and does not adequately meet the needs of these individuals. Some creative means of paying family doctors, pediatricians and obstetricians a fair rate to take care of all these patients is needed and some incentive system so that a greater percentage of these doctors would be willing to get involved.

I am proud that in the Opelousas area all of the pediatricians and most of the obstetricians and family doctors care for these individuals and they all have access to good medical care right in their local community. Unfortunately, this is not true through most of the state of Louisiana and this is one reason that our statistics on infant mortality is so much higher than the rest of the nation. Greater access and doctor involvement in the care of these patients is also one of the number one goals of the Louisiana State chapter of the American Academy of Pediatrics.



In discussing providing care to Medicaid patients with pediatric doctors around the state I hear complaints of the inefficiency of this system, the unfairness of the pay scale and the complexity involved in trying to get paid for routine services. I think a simpler, more uniform system could be worked out with fair payment for all services provided and the emphasis should be on paying doctors who spend time with patients. Particularly in preventive health care. Presently, there is payment for good physical exams, checkups, immunizations and preventive health care which is important in preventing much more expensive problems later.

I also think a co-pay system where individuals have to pay a nominal fee for the use of services would cut down on alot of the abuse of the system and allow doctors to better care for the ones who really need it and not get bogged down seeing two well patients for every sick patient. The cost of this would certainly require a little higher cost in administering the program but I think the savings would greatly outweigh it. Hopefully, all of our local, state and national legislators will get behind the American Academy of Pediatrics plan and help us to build a system which will begin to provide good sound medical care to all individuals in our society particularly children. We can then proudly hold our head up with the rest of the modern world and not be at the bottom of the pack of the modern industrial countries in providing care to our poor.