Children with public insurance are slightly
more likely to receive unnecessary medical
care than those with private insurance,
says a new study

Insured or not, unnecessary care is a problem among pediatric patients

January 09, 2020
by John R. Fischer, Senior Reporter
A study out of the University of Michigan says having public or private insurance makes little difference in the likelihood of a child receiving low-value care.

Researchers recorded one in nine publicly insured children receiving medical services they did not require, and the same for one in 11 privately insured children in 2014.

"While we found that publicly insured children were a little more likely to receive low-value services, the difference was not large,” said lead author Kao-Ping Chua, a pediatrician and researcher at Michigan Medicine's C.S. Mott Children's Hospital and the Susan B. Meister Child Health Evaluation and Research Center, in a statement. “The more important finding is that children are highly likely to receive wasteful care regardless of what type of insurance they have. This means that efforts to reduce waste should be global in nature and target the care of all children."

A prior study conducted by Chua and her team found that privately insured children frequently experience low-value services that do not improve their health. What it did not, however, address is that publicly insured children were more or less likely to receive the same.

For the current study, researchers estimated the prevalence of 20 low-value diagnostic tests, imaging tests, and prescription drugs, including unnecessary vitamin D screenings, imaging for acute sinus infections, and antibiotic prescriptions for colds.

Unnecessary services were distributed to 11 percent of publicly insured children and nine percent of privately insured at least once. About four percent and three percent, respectively, received low-value services at least twice. About one in 33 publicly and privately insured children underwent a low-value diagnostic test at least once in 2014. About one in 12 publicly and one in 20 privately insured children received a low-value prescription drug at least once.

The findings indicate that the type of insurance a child has is not a strong predictor of their likelihood to receive wasteful care, according to Chua. She attributes a large part of the issue to interventions by providers and family and a resistance to changing this interventionist culture of medicine.

"Parents understandably want to relieve their children's suffering and to rule out serious problems. Both parents and doctors sometimes have a tendency to believe that prescribing a drug or ordering a test is better than doing nothing, even though the right answer is often to do less,” she said, adding that “doctors have a strong fear of missing something. Some doctors would rather over-treat and risk the side effects of the intervention than under-treat and risk missing a catastrophic problem."

Performing unnecessary exams or procedures racks up healthcare costs and subjects patients to exams that can put their health at risk. Unnecessary MR exams, for instance, expose children to risks of sedation, while CT scans expose them to radiation, which increases their lifetime risk of developing cancer. A 2015 study at the University of California, Los Angeles found that 85 percent of ER doctors thought too many diagnostic exams were ordered in their EDs, and 97 percent reported that at least some of the advanced imaging exams they ordered were medically unnecessary.

"These interventions waste healthcare dollars that could be devoted to other valuable causes, and also force many families to pay out-of-pocket for unnecessary care," said Chau. "Reducing wasteful care will improve child health and decrease the financial burden of health care spending on society and families."

The study was published in the journal, Pediatrics.

The University of Michigan did not respond for comment.