Human Services News

Commonwealth Fund:

The importance of childhood preventive care has long been emphasized at the federal level, through such programs as the Maternal and Child Health Services Block Grant, Medicaid's Early and Periodic Screening, Diagnostic, and Treatment Program, and the State Children's Health Insurance Program.

In their study, "Preventive Care for Children in the United States: Quality and Barriers" (Annual Review of Public Health, Apr. 2006), the researchers focused on 58 large observational studies and interventions that addressed child care on four counts: frequency of visits, developmental and psychosocial surveillance, screening for diseases, and anticipatory guidance.

Attending Well-Child Visits Both the American Academy of Pediatrics and the federal Maternal and Child Health Bureau recommend six well-child visits in the first year, three in the second, and 17 from ages 2 through 21.

Estimates of the number of children who attend all their recommended visits vary widely by study (37%--81%), depending on whether the data were obtained from patient surveys or administrative records; whether children were enrolled in public health plans or private plans; and whether the subjects were children or adolescents.

While one study found that more than 80 percent of pediatricians said they always counseled on at least one of nine preventive health topics, such as car restraints, firearms, physical activity, and sexual health, most topics were discussed by less than half of pediatricians.

Breaking Down Barriers Several identifiable barriers to quality preventive care emerge from this study: insurance coverage; lack of continuity with a clinician or institution; deficient privacy for adolescents in clinical settings; clinician skill; race, language, and gender barriers; and shortage of time.

One survey showed that 76 percent of privately insured and 85 percent of publicly insured children satisfied well-child visit recommendations, compared with 68 percent of uninsured children.