INFECTIONS
January 16, 2020

Unnecessary Pediatric Care

Taking a child to the doctor for a cold or mild fever is an example of low value healthcare. It's usually a waste of healthcare resources and not as useful as doing nothing.

When a worried parent takes their child to the doctor for a cold, minor fever or upset stomach, the goal is usually to relieve the child's discomfort and reassure their parents. Doctors often oblige by prescribing cough remedies, pain killers or antibiotics even though they are not really necessary. These so-called “low-value” health interventions are more expensive and sometimes less effective than the alternative — doing nothing. Other examples of such unnecessary interventions include prescribing antibiotics or decongestants for a cold and ordering brain imaging for minor head trauma.

Since children often receive low-value health services, this means that resources meant to improve pediatric care may not be put to the best use. Unfortunately, researchers know little about what factors prompt the use of these interventions. A new study looked at whether the type of insurance a child has affects whether or not they receive low-value or unnecessary interventions.

Low-tech forms of relief like hot liquids and honey may be all that is needed. And you will avoid exposing your child to the germs lurking in the doctor's office.

Low-value services are a wasteful use of health care dollars, and they may force families to pay out-of-pocket costs for unnecessary care, Kao-Ping Chua, lead author of the study, explains. “Reducing wasteful care will improve child health and decrease the financial burden of health care spending on society and families.”

Chua and his team analyzed data for 8.6 million children in 12 states using three different claims databases. They compared the proportion of publicly-insured children who received 20 unnecessary or low-value tests or medications at least once in 2014 to the proportion of privately-insured children receiving the same sorts of unnecessary care.

Children are likely to receive wasteful care regardless of their insurance. The researchers found that one in nine publicly insured children and one in 11 privately insured children received unnecessary care, an insignificant difference. “This means efforts to reduce waste should be global in nature and target the care of all children,” said Chua, a pediatrician and researcher at the C.S. Mott Children’s Hospital and the Susan B. Meister Child Health Evaluation and Research Center at the University of Michigan.

The idea of intervention is deeply-rooted in the culture of medicine, and it is an important reason why children receive low-value services despite evidence these services don’t work, he explained. Parents want to help their sick child and rule out serious medical conditions, which is understandable. If parents miss work and their child misses school to go to the doctor, or if their child has previously received the same intervention for the same condition, they are more likely to think an intervention is needed.

For their part, doctors have a strong fear of missing something, and may act out of an overabundance of caution. Some doctors would rather overtreat and risk the side effects of an intervention, then undertreat and risk missing a catastrophic problem. “So parents and doctors have a tendency to think prescribing a drug or ordering a test is better than doing nothing, even though the right answer is often to do less,” Chua said.

The message for parents is to think before you head to the pediatrician's. Is the visit really necessary, or is it safe to give your child a day to rest and recover and see how he or she is feeling after another 24 hours? Warm liquids, hot compresses and other low-tech forms of relief may be all that is needed. And you will avoid exposing your child to the germs that may be present at the doctor's office.

The study is published in Pediatrics.
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