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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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Mayo Medical School
23 July 2011
“Denver boy, 9, died after state-benefits error denied him asthma medication,” last modified March 2, 2010, http://www.denverpost.com/ci_14329527
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
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
by State, 2007-2008
< 9% (20 states and DC)
9-12% (21 states)
US Average = 11%
> 12% (9 states)
Low physician participation
Stretching the net too thin
“The Sick Child” by Gabriel Metsu
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?
Study Objectives: To determine how
Pediatricians perceive their professional responsibility
Accept potential consequences of healthcare reform
Compare to other groups of physicians
Mailed Survey in 2009
2000 practicing U.S. physicians; 241 pediatricians
65 years of age or younger
Random selection from the AMA Physician Masterfile
From all specialties:
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
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
54% response from eligible physicians
60% response from practicing pediatricians
Cooperation rates did not vary by
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
Mobilization of pediatricians as a group
Majority of pediatricians express willingness to
Expand basic healthcare access
Treat the uninsured and underinsured
Recognize their societal responsibilities
This data provides a sound basis upon which to mobilize pediatrician support for major public policy initiatives needed to improve care for children
Limited sample size
Specific aspects of Healthcare reform addressed
Physician Involvement in Healthcare Reform is Essential
Joycelyn Elders, former surgeon general speaks on healthcare reform
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