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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 “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 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 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
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 • 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 Difficulties: Rising costs Slow reimbursement Low physician participation Stretching the net too thin
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 • 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 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 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 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 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 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 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 85% 85% 77% 77% 77% 77%
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
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 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, 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 Cross-sectional data Limited sample size Specific aspects of Healthcare reform addressed
"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! 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@example.com
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