Evidence that children with private or Medicaid coverage both at risk of low-value care

A new study finds that both Medicaid and privately insured children frequently receive healthcare services that do not improve health. There has been an assumption that because providers are paid less by Medicaid, they have no incentive to provide unnecessary services. The study, published in Pediatrics, analyzed records from almost 7 million American children in 12 states and found that 11.0% and 8.9% of Medicaid and privately insured children, respectively, in 2014 received at least one of 20 low value diagnostic tests, imaging or prescription drugs without a medical reason. The states were not identified. Low value services are more expensive than equally or more effective alternatives, including watchful waiting. Not only does low value care waste precious health dollars and capacity for those truly in need, it can also compromise health outcomes. Overuse of antibiotics can result in antibiotic resistance and unnecessary imaging can involve radiation and sedation. Services studied included universal screening for Vitamin D deficiency, prescription antibiotics for a cold, and sinus imaging in children with acute sinusitis. Many of the twenty services are usually not offered directly by the child’s primary care provider, and so may not affect their incentives. The study also lends credence to providers who say they treat all patients the same, regardless of payer source. It is important to note that equal levels of over-service on some metrics does not address the reality of under-service for Medicaid and uninsured patients, strongly supported in the literature.