Trends in Pediatric Primary Care Visits Among Commercially Insured US Children, 2008-2016

Abstract

IMPORTANCE Primary care is the foundation of pediatric care. While policy interventions have focused on improving access and quality of primary care, trends in overall use of primary care among children have not been described.OBJECTIVE To assess trends in primary care visit rates and out-of-pocket costs, to examine variation in these trends by patient and visit characteristics, and to assess shifts to alternative care options (eg, retail clinics, urgent care, and telemedicine). DESIGN, SETTING, AND PARTICIPANTSObservational cohort study of claims data from 2008 to 2016 for children 17 years and younger covered by a large national commercial health plan. Visit rate per 100 child-years was determined for each year overall, by child and geographic characteristics, and by visit type (eg, primary diagnosis), and trends were assessed with a series of child-year Poisson models. Data were analyzed from November 2017 to September 2019. MAIN OUTCOMES AND MEASURESVisits to primary care and other settings.RESULTS This cohort study included more than 71 million pediatric primary care visits over 29 million pediatric child-years (51% male in 2008 and 2016; 37% between 12-17 years in 2008 and 38% between 12-17 years in 2016). Unadjusted results for primary care visit rates per 100 child-years decreased from 259.6 in 2008 to 227.2 in 2016, yielding a regression-estimated change in primary care visits across the 9 years of −14.4% (95% CI, −15.0% to −13.9%; absolute change: −32.4 visits per 100 child-years). After controlling for shifts in demographics, the relative decrease was −12.8% (95% CI, −13.3% to −12.2%). Preventive care visits per 100 child-years increased from 74.9 in 2008 to 83.2 visits in 2016 (9.9% change in visit rate; 95% CI, 9.0%-10.9%; absolute change: 8.3 visits per 100 child-years), while problem-based visits per 100 child-years decreased from 184.7 in 2008 to 144.1 in 2016 (−24.1%; 95% CI, −24.6% to −23.5%; absolute change: −40.6 visits per 100 child-years). Visit rates decreased for all diagnostic groups except for the behavioral and psychiatric category. Out-of-pocket costs for problem-based primary care visits increased by 42% during the same period. Per 100 child-years, visits to other acute care venues increased from 21.3 to 27.6 (30.3%; 95% CI, 28.5% to 32.1%; absolute change: 6.3 visits per 100 child-years) and visits to specialists from 45.2 to 53.5 (16.4%; 95% CI, 14.8% to 18.0%, absolute change: 8.3 visits per 100 child-years).CONCLUSIONS AND RELEVANCE Primary care visit rates among commercially insured children decreased over the last decade. Increases in out-of-pocket costs and shifts to other venues appear to explain some of this decrease.

Pediatric outpatient utilization by differing Medicaid payment models in the United States

“…Since then, studies of Medicaid payment models in children have been limited to primary or preventative care, or limited to children with special healthcare needs or based on self-report [15][16][17]. Recent studies on outpatient utilization in the commercially insured population include urgent care (UC), however data on UC utilization in the Medicaid population are lacking [18,19]. UC visits are one example of possible healthcare cost savings, as they are significantly less expensive than ED visits for comparable illnesses, and are an increasingly used venue for low acuity conditions [18,20].…”

Bringing research directly to families in the era of COVID-19

“…The pandemic accentuates existing trends in the pediatric ambulatory healthcare landscape, with increasing consumerism among families creating uncertainty about the future of current care models. 11 Direct-to-family research is an unprecedented opportunity to respond to these evolutions in pediatric care and increase access to clinical trials during the COVID-19 pandemic and beyond. Herein we share key principles to facilitate the planning, design, and implementation of direct-to-family research studies.…”

The Role of COVID-19 in Transitioning to a Better Pediatric Payment Model

“…This pandemic-induced drop came on top of the decade-long decline in office visits pediatricians were already experiencing amid increasing competition from urgent care centers and retail clinics, which may undermine the primary carefamily relationship. 3,4 In order to stabilize their revenue and provide service to patients, many pediatricians have rapidly accelerated the use of telehealth visits and have clamored for increased reimbursement equal to in-person care. However, similar to the situation with urgent care and retail clinics, patients can access telemedicine services outside of the medical home from a wide variety of market competitors and continued payment parity from insurance companies for telehealth services is not assured.…”