U.S. Kids Not Getting Needed Health Care

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Smith and her colleagues analyzed outpatient medical records for 1,536 children in 12 U.S. metropolitan areas to see how actual care compared with 175 quality indicators.

On average, children in the study received 46.5 percent of the indicated care; 67.6 percent of the indicated care for acute medical problems, 53.4 percent of indicated care for chronic medical conditions, and 40.7 percent of the indicated preventive care.

Quality varied according to the clinical area, ranging from 92 percent adherence for respiratory tract infections to only 34.5 percent for preventive services for teens.

Fewer than 50 percent of children who reached 2 years of age during the study period were fully immunized.

Only 31 percent of children aged 3 to 6 had their weight measured at their annual check-up. "How do we catch a child at risk for obesity if we don't look?" Smith said. "How do we prevent complications if we don't follow weight?"

Similarly, only 19 percent of seriously ill infants had the right lab tests, only 44 percent of those with asthma were on the right medication, and only 38 percent of children were appropriately screened for anemia in the first two years of life.

And these results were a best-case scenario. "The majority of these children were white, middle- to upper middle-class with private health insurance," Smith said. "Most people assume they're getting excellent health care, and, unfortunately, they're not."

Gaps in preventive care were among the most glaring.

"As a pediatrician, I was shocked by some of our findings, especially those related to preventive care and screening," Smith said. "Prevention is the bulk of what we do. I even re-screened the charts, because I couldn't believe the results."

Why are these deficits happening?

Partly because of the structure of the health-care system, which pressures physicians to see as many patients as possible in a short period of time, Smith suggested. "In a lot of cases, the annual check-up gets a 10-minute slot on a doctor's schedule," she said. "How can we accomplish all we are supposed to do and give parents time to voice their concerns?"