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Who’s Responsible for the Children? Physician Social Responsibility & Healthcare Reform: A National Survey. Erin O’Donnell Mayo Medical School 23 July 2011. Lack of Insurance Drastically Affects a Child’s Chance of Growing up in Good Health.

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slide1
Who’s Responsible for the Children?Physician Social Responsibility & Healthcare Reform: A National Survey

Erin O’Donnell

Mayo Medical School

23 July 2011

lack of insurance drastically affects a child s chance of growing up in good health
Lack of Insurance Drastically Affects a Child’s Chance of Growing up in Good Health

“Denver boy, 9, died after state-benefits error denied him asthma medication,” last modified March 2, 2010, http://www.denverpost.com/ci_14329527

presentation overview
Presentation Overview

Problem of uninsured and underinsured children in the US

Health insurance programs for children:

Medicaid and SCHIP

Elucidating how pediatricians perceive their role in healthcare reform

Methods of surveying pediatricians

Majority of pediatricians acknowledge their responsibilities

Efforts to mobilize pediatricians in reshaping US healthcare

millions of children face healthcare disparities
Millions of Children Face Healthcare Disparities

8 million uninsured children, 10.4%

Majority come from working families

10 times more likely to have unmet medical needs

Lack of preventative care

More likely to perform poorly in school

Disproportionately affects minority children

1 in 5 Latino children are uninsured

slide5

Uninsured Rates for Children under 19,

by State, 2007-2008

NH

VT

ME

WA

MT

ND

MN

MA

OR

NY

SD

WI

ID

RI

MI

CT

WY

PA

NJ

IA

NE

OH

IN

DE

NV

IL

WV

UT

VA

MD

CO

KY

KS

MO

CA

NC

DC

TN

OK

SC

AR

AZ

NM

GA

MS

AL

TX

LA

AK

FL

HI

< 9% (20 states and DC)

9-12% (21 states)

US Average = 11%

> 12% (9 states)

medicaid is the major health coverage program for children
Medicaid is the Major Health Coverage Program for Children
  • 29 million children enrolled in Medicaid
  • 44 states cover children in families with incomes at 200% of FPL
  • Federal government matches state spending
medicaid doesn t always act as a safety net
Medicaid Doesn’t Always Act As a Safety Net

Difficulties:

Rising costs

Slow reimbursement

Low physician participation

Stretching the net too thin

president obama signs legislation to expand schip coverage
President Obama Signs Legislation to Expand SCHIP Coverage
  • Reauthorization of SCHIP
  • Signed on Feb. 4, 2009
  • Expanding coverage
    • Immigrant Children
    • Pregnant mothers
  • Increase SCHIP spending
  • Helping the most vulnerable
physician participation is essential for healthcare reform
Physician Participation is Essential for Healthcare Reform
  • Children as a vulnerable population
  • Physician ethos:
    • Promote good
    • Avoid harm
  • Physicians to advocate for:
    • Improved care delivery
    • Lower costs
    • Better health outcomes

“The Sick Child” by Gabriel Metsu

underlying questions regarding child healthcare reform
Underlying Questions Regarding Child healthcare Reform

Do pediatricians have a greater responsibility to their patients than non-pediatricians?

What role can pediatricians play in health reform?

What are pediatricians willing to do or accept to improve healthcare?

understanding how pediatricians perceive their societal responsibilities
Understanding how Pediatricians Perceive their Societal Responsibilities

Study Objectives: To determine how

Pediatricians perceive their professional responsibility

Accept potential consequences of healthcare reform

Compare to other groups of physicians

methods data source
Methods: Data Source

Mailed Survey in 2009

Participants

2000 practicing U.S. physicians; 241 pediatricians

65 years of age or younger

Random selection from the AMA Physician Masterfile

From all specialties:

Primary care

Procedural/surgical

Nonprocedural specialty

methods data source14
Methods: Data Source

Criterion Variables

Favor limiting reimbursement for expensive drugs and procedures to help expand access to basic healthcare

Every physician is professionally obligated to care for the uninsured and underinsured

Addressing societal health policy issues falls within the scope of physician professional obligations

methods data analysis
Methods: Data Analysis

Descriptive Statistics

Response rate

Demographics

Self-ratings as “conservative”, “moderate” or “liberal”

Responses to items relevant to healthcare reform

Differences between pediatricians and non-pediatricians

Multivariate Logistic Regression

Adjusted for age, sex, region

results survey demographics
Results: Survey Demographics

Response rate

54% response from eligible physicians

60% response from practicing pediatricians

Cooperation rates did not vary by

Age

gender

Region

results majority of pediatricians agree to their responsibilities in healthcare reform
Results: Majority of Pediatricians Agree to their Responsibilities in Healthcare Reform

85%

85%

77%

77%

77%

77%

results pediatricians are more likely to favor certain elements of healthcare reform
Results: Pediatricians are more likely to Favor Certain Elements of Healthcare Reform*

Pediatricians vs. Non-pediatricians

Limiting reimbursement for expensive treatment

OR, 1.6; 95% CI, 1.1-2.4

* Results are adjusted for age, sex, and region

results positions vary amongst pediatricians
Self-identified “Liberal” vs. “Conservative”

Responsibility to address societal health policy issues

OR, 6.1; 95% CI, 1.5-25.7

Limiting reimbursement for costly interventions

OR 5.0; 95% CI, 1.5-16.8

Results: Positions Vary Amongst Pediatricians*

* Results are adjusted for age, sex, and region

conclusion pediatricians are willing to participate in healthcare reform
Conclusion: Pediatricians are willing to participate in Healthcare Reform

Mobilization of pediatricians as a group

Majority of pediatricians express willingness to

Lower reimbursement

Expand basic healthcare access

Treat the uninsured and underinsured

Recognize their societal responsibilities

in summary
In Summary,

This data provides a sound basis upon which to mobilize pediatrician support for major public policy initiatives needed to improve care for children

limitations of research study
Limitations of Research Study

Cross-sectional data

Limited sample size

Specific aspects of Healthcare reform addressed

slide23
"Not to know is bad; not to want to know is worse. Not to hope is unthinkable. But for us not to care is absolutely unforgivable."

Physician Involvement in Healthcare Reform is Essential

Joycelyn Elders, former surgeon general speaks on healthcare reform

thank you
Thank you!

Ryan M. Antiel, MA (Mayo Medical School)

Katherine M. James,MPH (Program in Professionalism and Bioethics)

Jason H. Homme, MD (Department of Pediatric & Adolescent Medicine)

Jon C. Tilburt,MD, MPH (Division of General Internal Medicine; Program in Professionalism and Ethics)

[email protected]

references
References

Antiel RM, Curlin FA, James KM, et al. Physicians’ Beliefs and U.S. Health Care Reform—A National Survey. N Engl J Med. 2009;361(14):e23.

Fisher ES, Berwick DM, Davis K. Achieving health care reform—how physicians can help. N Engl J Med. Jun 11 2009;360(24):2495-2497.

“Looking Back on Cover the Uninsured Week,” last modified June 2011, http://covertheuninsured.org/content/children

“Medicaid and the Uninsured,” last modified February 2009, http://www.kff.org/medicaid/upload/7863.pdf

“The Sick Child,” accessed July 1, 2011, http://www.rijksmuseum.nl/aria/aria_assets/SK-A-3059?lang=en

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