Trends in Pediatric Well and Sick Visits, 2002-16

Tang, Suk-fong S. ; Cull, William L. ; Olson, Lynn M.

¹Am Acad Pediatrics (AAP), Itasca, IL 

Presented at the 2019 Pediatric Academic Societies Annual Meeting.

Background: Since the early 2000s more children are covered by health insurance, and parents report greater access to care. At the same time, there have been ongoing changes in the health system and progress in the prevention and treatment of illness in pediatrics.

Objective: Examine trends in well versus sick primary care physician office visit rates for publicly-insured and privately-insured children.

Methods: We used 15 years of nationally representative data from the 2002-16 Medical Expenditure Panel Survey/MEPS, creating a sample of children and adolescents age 0 to 21 who had either public (Medicaid/CHIP) or private insurance for a full year in the year they were surveyed (unweighted n=122,859). We examined total physician office visits, as well as well and sick visits separately using general linear models to test for time trends. Physician office visits included pediatricians as well as other physicians reported by the household. Sick visits included diagnosis and treatment, emergencies, mental health, and follow-up visits. Well visits included well-child exams, immunizations or shots, and general check-ups. 

Results: Within our analyses, 67.6% of full year-insured children were reported to be privately-insured and 32.4% were reported to be publicly insured. For both privately-insured (B = .008, 95% CI = .006; .011) and publicly-insured (B = .006, 95% CI = .002; .010) children, the frequency of well-visit rates increased across the study period (Figure). Across this same time period there was an associated decrease in the number of household-reported sick visits for both publicly-insured (B = -.026, 95% CI = -.032; -.020) and for privately-insured children (B = -.029, 95% CI = -.034; -.024). The decreases in sick visits were greater than the increases in well visits resulting in a net reduction in total reported visits from 2002 to 2016 for both privately-insured (B = -.021, 95% CI = -.027; -.015) and publicly-insured children (B = -.021, 95% CI = -.029; -.012).

Conclusion: Using household-reported data we found a pattern of increased use of well visits and decreased sick visits across the last decade and half, resulting in a net decrease of roughly a third of a visit per child since 2002. The pattern was consistent for privately and publicly insured children. Multiple factors likely account for these trends, including the possibility that greater use of well visits and improvements in medicine may be helping to improve child health. Future studies can utilize multiple data sources to better understand these trends.