Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: Insurance System Doesn't Work for Chronically Il

Category: Access To Children's Health Care


Families of chronically ill children rapidly find out that their insurance coverage is not always committed for the long haul. Frequently, the company will put pressure on the employer by raising costs of every employee in the company unless that particular family is dropped. Sometimes the family is told that their rates will go from a few hundred dollars a month to several thousand dollars a month to literally force them out of coverage as soon as possible. The American Academy of Pediatrics feels that insurers should not be able to act this way.

It is estimated that approximately 10% of the United States children are affected by chronic health problems ranging from respiratory system and sever allergies to learning disabilities and mental and nervous system disorders. Most employer based insurance coverages are adequate for traditional medical services but many fall short of covering needed services such as physical therapy, speech therapy, occupational therapy, mental health counseling, and long term care.

Patients with many chronic illnesses have in addition to the medical illness, emotional and social needs. Because of this it is important that comprehensive medical care is available to provide treatment for all of the needs of the individual. They may need psycho- social interventions with mental health counseling to handle the emotional difficulty of their chronic illness and disability. We need insurance which will better cover the whole patient's needs and not just hospitalization for acute illnesses.

The American Academy of Pediatrics, as part of their "Children First" agenda, is promoting the Matsui Bill which is part of House Resolution 3393 introduced this past year. This bill would solve the need for good broad coverage for all children and would also allow poor children who now have no access to even basic health care to be taken care of equally with uninsured children. The cost of medical care increases daily as we wait longer and longer to arrive at a comprehensive solution. The cheapest, smartest and most moral first step, in my opinion would be to start by providing basic health care at least to the children in our society and then gradually to work up to the entire society, so that we can come into the 21st century like the other modern industrialized nations which already provide this for their citizens. Please help me and the American Academy of Pediatrics by supporting the Matsui Bill in Congress and encouraging your legislators to get behind it.