At a time when more and more Americans are realizing that an ounce of prevention is worth a pound of cure, it's alarming that the present system of health reimbursement will not support them in their efforts to stay well.
For example, if a mother takes her 6-year-old to the doctor for treatment of a serious bout of measles, her insurance will reimburse her for the visit. Yet if a mother brings in a healthy child for an annual check-up and preventive measles shot, she almost always must pay the bill.
The sad truth is that the U.S. health care system focuses on illness, with relatively little money spent on staying well. This is particularly a problem for children, whose health needs are different -- and less costly -- than those of their parents.
Health supervision, to make sure a child is progressing properly and that potential problems -- such as poor hearing or vision -- are caught early, is vital to children's well-being. The American Academy of Pediatrics recommends children see a pediatrician every two months for the first six months of life, every three months until the end of the first year, every six to 12 months until they are school age and once a year in school. During these check-ups the pediatrician can uncover important factors that could prevent future health disasters.
It was in just such a check-up that a 2-year-old who was thought to be extremely hyperactive was discovered to have a hearing problem. When he was fitted with a hearing aid, he no longer demonstrated hyperactive behavior.
In addition to helping people stay well, preventive care also saves money in the long run. The AAP has found that no fewer than 15 studies have shown that meeting children's unique needs for preventive services reduces illness and health care spending. For every dollar spent on measles immunizations, for example, we save approximately $10 in disease-related costs.
Yet most insurance plans do not pay for "well child" care. As a result, people often delay going to the doctor until a concern becomes a crisis -- and is therefore covered by insurance -- because their policies do not cover routine check-ups. The child often must be in pain or running a high fever before he or she has the benefit of a doctor's care. The term "health supervision" should replace "well" baby or child care and the program should cover the entire life of the child.
America should be taking a leadership role in keeping our children well and out of hospitals by funding the type of medical care that is conducive to health. It is time that we begin to convince third-party payers, including the government, how important it is to provide reasonable financing for continuous comprehensive, personalized medical care for our children and ourselves. This will promote not only the physical and mental health of our population, but also the optimum growth and development of our country's children.
Coverage for preventive health check-ups should be the same as coverage for illness. If we do not provide preventive care maintenance, we encourage people to wait for preventable problems to turn into serious illnesses. Insurance plans should not discriminate against preventive health supervision by requiring higher co-insurance payments or higher deductibles.
Newborn coverage shouldn't differentiate between the so-called routine newborn care and the infant who is sick. Parents need supportive help as the first months of life may be crucial. Detecting defects at birth may prevent the child from developing something more serious in later life.
All testing for acute illnesses, routine nursery care, and circumcision should be covered. If the pediatrician is present at a cesarean section or a high-risk delivery, he or she should be reimbursed.
Laws in every state mandate that all children be immunized against infectious disease. Yet immunizations are not generally covered by private health insurance.
A move away from this "sickness only" system into a health-oriented one comes with the Child Health Incentives Reform Plan, a bipartisan bill sponsored by Sen. John H. Chafee (R-R.I.), Sen. Claiborne Pell (D-R.I.) and Rep. Ed Jenkins (D-Ga.), which would require businesses to include children's preventive health care in their employe health plans to keep insurance premiums tax deductible.
AAP is one of several organizations to support this bill. AAP president Dr. Robert J. Haggerty recently testified before the Senate Finance Committee's subcommittee on taxation and debt management that health care costs could be reduced by amending the Internal Revenue Code to deny any employer a deduction for group health plan expenses unless the plan includes coverage of pediatric preventive care.
"There is only one way to reverse the inflationary influence of illness-oriented health insurance," Haggerty said. "And that is to change the nature of insurance to encourage prevention and early diagnosis of disease."
The place to begin is with children's coverage, where the research has shown there would be the highest payoff.
John L. Chamberlain III is a Bethesda pediatrician and alternate chairman of the D.C. Chapter of the American Academy of Pediatrics.