The real cost of unnecessary pediatric medical services

When children are sick, parents will do everything they can to help them. However, parents' judgment of the situation may often be exaggerated, which can lead to unnecessary stress, and overuse of emergency rooms and other medical services. To alleviate this issue, parents need to be equipped with tools to help them better understand their children’s symptoms and improve their communication with nurses and pediatricians.

The misuse of medical services occurs when they are requested without the actual need or are misdirected. How often does this happen in the case of parents seeking the best care for their children?

According to research conducted by the CDC, over 19% of children under the age of 18 visited the ER at least one time in 2018. In a more detailed study from 2012, the CDC concluded that many of them could be avoided as the main reasons for visiting the ER were that “only hospitals could help,” their regular doctors’ offices were not open, or there was no other place to go. These results demonstrate that parents are often lost in the system and unsure of what to do.

A large portion of parents are visiting the ER with children at relatively uncommon times: approximately 75% of children's visits to the ER take place at night or on weekends, when the ER is the only place where necessary help is available.

Interestingly, families deciding to visit the ER at night or on weekends present different characteristics than those who visited the ER in the daytime. These children were more likely to be ill for a shorter period of time, spend their days in school or daycare, have parents that first attempted treatment at home, and have access to private physicians. Their core reason to visit the hospital at night was illness concerns.

The reasons for this behavior might vary. As physicians and healthcare providers, we should consider that parents often seek the best ways to combine their parental responsibilities, work, and other obligations. After a busy day, the evenings are when parents finally have more time to spend with their children. This may lead to anxiety and distress, both of which do not help to facilitate making unplanned decisions.

Similar behavior, with some variations, is present across all patients - those covered with private insurance or Medicaid, as well as those who are uninsured.

The most visible result of unnecessary visits to the emergency room is most likely the cost, which in many cases is excessively high. According to UnitedHealthcare, a single visit to an ER in the United States costs, on average, $2,032. Considering the most common reasons why parents show up in the ER, presented above, in many cases, accurate care could be provided in less expensive settings such as urgent or primary care, costing less than $300.

The growing costs of medical services are a struggle for parents, especially those without medical insurance. Unfortunately, only 55% of children in the US were covered by private health insurance in 2018. In these cases, reducing unnecessary medical costs is a way to help families avoid stressful situations like burdensome bills or even bankruptcy.

Patient stories collected in the vox database provide numerous examples of ER patients treated with basic medical care and charged hundreds or thousands of dollars. Among them, the story of a 2-year-old boy with a bill for $2,400 for IV hydration and three over-the-counter medications, and a 9-year-old whose parents received a $3,100 bill issued by South Carolina Hospital for urine analysis and X-ray.

These costs, while severe for parents, are also a burden for the entire healthcare system. For example, although the US has similar patient rates, the country spent two times more on healthcare than other high-income countries (including the UK, Japan, and Sweden). It is therefore vital that medical facilities use their personnel, time, budget, means of transportation, supplies, and equipment to help those who genuinely need acute medical care. Improving their performance would also impact costs and processes on the insurer’s side.

Emergency centers are prepared to aid in life-threatening illnesses and injuries. However, when a large number of pediatric patients with non-urgent cases appear in an ER, their flow is disturbed. Specialty physicians and nurses segregate, engage and consult with everyone who comes in. They complete the work that could be equally performed by medics with basic training and at a lower cost outside of the ER.

Another issue is the waiting time for each visit. With more patients in ERs and urgent cases requiring immediate attention, children with general issues wait to be seen by a doctor. Additionally, most visits take place in the night hours or at weekends when there is less medical staff available, prolonging wait times by up to a few hours.

Last but not least, patient intake and evaluation documentation, which is completed under pressure and stress, tends to be incomplete or error-prone.

Read more on this issue.

Waiting all night to get help for your child could be as frustrating as having to decide between treating a small child or adult first, but these are the short-term effects of misusing medical services. On one side, providers are exposed to demanding and responsible work, whose fatigue can lead to making wrong decisions. On the other, parents are seeking immediate care for their little ones. In this stressful environment, communication, cooperation, and trust break down between both groups and this can result in less optimal care for the child.

Infermedica’s internal research discovered that both physicians and patients find the other side often unprepared for the visit, chaotic, and focused on documentation more than on mutual dialogue.

Instead of receiving professional help in a timely manner, parents might be hesitant to visit clinics and instead seek help on the Internet or experiment with home treatment methods.

One way to improve this situation is cost reduction and workflow optimization on the side of medical facilities. However, the success of diagnostic and treatment processes also lies in the hands of parents. Digital health tools available on the market today, such as symptom checkers, can provide parents with reliable medical guidance for their children at any time of the day or night.

These tools lead parents step by step through an initial dynamic interview on behalf of their child. While using AI to ask complementary questions about the possible reasons for the symptoms, they learn more about the child’s health and the most probable conditions. Importantly, some symptom-checking tools also instruct parents on how to search for causes of symptoms at home, ask them about the symptoms they didn't even think about, and help them identify possible urgent situations.

With this information, parents are more aware if they should act immediately or plan medical consultation in the next few days. They are also equipped with an organized set of health information that will simplify communication with providers. For example, a medical facility can use the information to propose the optimal time for the visit, as well as provide pediatricians with the child’s health info ahead of time.

See how Infermedica’s technologies can support your organization in providing symptom assessment and triage for the pediatric population. Get in touch with our team.

BL/EN/2021/07/28/2