Utilization of pediatric health services in Jerusalem

Abstract

The high rate of utilization of health services and rising health care costs in Israel, have prompted the need for reform of the health care system. Preventive and curative aspects of mother and child health care in Israel have traditionally been addressed by independent but parallel health systems. Prior to the pilot integration of these services, current patterns of utilization of health services by children during their first year of life, and determinants of use, were analyzed. Mothers of 651 children from five neighborhoods, representing the middle-low, middle and upper social class Jewish population were interviewed. Overall, a high degree of compliance with recommended visits to the preventive family health centers was found, with an average of eleven visits to the public health physician or nurse. The children also made an average of 12 visits to curative practitioners. Combined with all other health care consultations, these children averaged 26 health care visits in the first year of life. This pattern of frequent visitations, and its determinants, is discussed in context of the current framework of parallel health care systems. Multivariate analysis revealed that the birth order of the child was the key factor in determining the number of preventive visits, while the mother's perception of her child's health status held the major influence on the number of curative visits. No association between utilization of services and social class was discovered. Comparison of utilization patterns arising from this study with subsequent investigation of the planned integrated services allows for the assessment of the effects of a major change in the structure and delivery of pediatric services.

Pediatric care for preterm infants after NICU discharge: high number of office visits and prescription medications

“…Increased GA was associated with decreased visits, but the average total visits per year for 31-to 32-week infants (17 visits per year) remained higher than the anticipated 12 visits per year for infants in the general population. [13][14][15][16] The frequency of WCC visits was constant and consistent with guidelines. The extra visits per year for preterm infants were attributed to non-well pediatric and specialty care.…”

“…This high number of visits is even greater than that reported for a KPMCP NICU infant cohort and much greater than that reported for healthy term infants in a variety of outpatient settings. [13][14][15][16] High utilization occurred despite the cohort exclusion of the sickest infants, those who required VP shunts or home mechanical ventilation, and the exclusion of prescriptions for over-the-counter medication, vitamins and nutritional products. Frequent non-well visits to the pediatrician or specialist for nonwell care explained the extra number of visits and most prescriptions were for antibiotics and respiratory medication.…”

“…[13][14][15][16] We defined the high prescription user group as infants with >5 prescriptions because this figure was twice the average number of prescriptions in this cohort and greater than the reported three to four prescriptions per year in 0-to 4-year olds. 17 Statistical analysis w 2 Test and Student's t-test were used to identify differences between groups for categorical and continuous variables, respectively.…”

“…Term newborns without morbidities can expect to have, on average, 12 visits in the first year. [13][14][15][16] Descriptive studies often do not capture individual patient level follow-up and have not reported specifically on infants. The 2002 Medical Expenditure Panel Survey study reported four to five health-care visits and three to four prescriptions per year for 0-to 4-year olds.…”

The relationship between the use of primary health care and infant health status at 12 months in a Brazilian community

“…Our findings can be compared with those of Neumark et al 16 , who analyzed the utilization of health services among infants in Israel. They estimated an average of 12.3 medical appointments for curative care and 2.6 for preventive care, totaling 14.9 appointments per infant during the first year of life.…”