Back from the Mountains: The Cost of Children's Health

I saw patients today, 9 physicals with negative behavioral health screens, a bunch of kids with acute medical problems, a few behavioral/mental health follow-ups and no contact with the CBHI. It is really odd to think that I will be leaving the practice in a mere 14 days, and that I only have 6 more days of clinical pediatrics before I descend into the maelstrom of Washington politics.

One of the reasons that children are often absent from the discussion of health reform is that, in general, child health is a small percentage of the cost of health care (some colleagues refer to the cost of "child health" as a rounding area when compared to the cost of care for the elderly). My AAP News today, however, suggested that we should be looking at this in a different way. According to a recent study by AHRQ, $98.8 billion was spent on children's medical care in 2006. Please note that this is in the context of $2 - $3 trillion of total expenditure on health care, so that is a mere 5% of the healthcare pie. 5 conditions account for 30 % of that spending, and mental health costs led the way in terms of expected outlay. As the same time, it turns out that the insurers have managed to turn this one into a massive cost shifting to the consumers. When one looks at the percentage of that cost that is paid out of pocket by parents, 21% of the bills are shouldered by parents, in the context of a system that most would consider to be woefully inadequate, compared to 11 % of the bills in the case of infectious disease. These data confirm what we already knew- that a substantial part of the problem of access to health care for children is access to mental health services, and that the system is designed to restrict access as a means of cost control. Clearly, for children, this message needs to be heard in the discussion on Capital Hill.