Parents do not need to look far for alarming news that children’s hospitals are experiencing bed shortages and long wait times to see pediatric specialists as the flu and respiratory syncytial virus (RSV) wave worsens. According to the CDC, a third of flu-related hospitalizations are in children and RSV cases are on the rise in at least 32 states. Last month, the American Academy of Pediatrics joined us in calling on the White House to declare a national emergency due to child respiratory infections and to provide additional funding and resources to help cover the capacity of care. We’re grateful the Biden administration clarified that the flexibilities hospital systems were given during COVID-19 to ease certain staffing requirements also apply to RSV and flu. Despite this, more work needs to be done if we are to get to the root of the issue.
Even before the COVID pandemic, pediatric programs in community hospitals have been in decline for many years. The specialists who care for essential health needs like mental health, adolescent medicine, and neurology, have similarly been in short supply for a long while. This shortage developed even as demand for pediatric health care for our nation’s 76 million children has increased. There is no mystery about why supply isn’t keeping up with demand.
Simply put, there is a devastating lack of financial prioritization across our nation’s health care system. Most of the care for children by pediatric hospitals, pediatricians, and family physicians are reimbursed at lower rates than adult care. The training of pediatric residents is financed at lower levels than physicians trained to care for adults. Pediatricians make less money than their physician counterparts focused on the care of adults, despite accruing the same medical education debt. Without the essential financial support of private commercial insurance and community philanthropy to children’s hospitals to offset the low reimbursement of the Medicaid program, the pediatric hospital industry in the United States would be unsustainable as we know it.
All hospitals and aspiring physicians, confronted with choosing between adult programs and practices versus pediatric health care, are incented to choose the former. In so doing, they are making rational economic decisions and will continue to do so until we change the math. The situation is clear: pediatric health care capacity will struggle to meet demand in a nation which values adult health care and providers at comparatively higher levels.
The necessary solutions are well known and simple:
Reimburse pediatric health care services – physical and mental – in Medicaid at comparable levels paid by Medicare for adult health care. Medicaid is the primary insurance program for children, covering over 40 million children. Medicare is the primary payor program for older adults, covering over 50 million adults. Continuing to pay for adult care in Medicare at higher levels reinforces provider incentives to focus on adults.
Invest in the training of physicians caring for children at a comparable amount provided to physicians focused on the care of adults. The Children’s Hospital Graduate Medical Education program, or CHGME, trains half of the nation’s pediatricians and most pediatric specialists at the same levels of costs as the training of physicians focused on the care of adults. Despite similar costs, the CHGME program for pediatricians is funded at half the amount of the Graduate Medical Education program, or GME, supporting the training of all other U.S. residencies. Continuing to fund CHGME at far lower levels than the GME program weakens the pediatrician workforce by placing greater financial burden on the training pipeline. Without changes, we can expect both hospitals providing clinical programs and future physicians making career choices that will continue to prioritize their adult-focused options over pediatrics.
The primary challenge in sustaining a robust health care delivery system for children – from primary care pediatricians to advanced care in children’s hospitals– is financial. Federal spending on health care per adult is much higher than what is spent per child. Despite children constituting 22 percent of the U.S. population, a far lower proportion of the federal health budget is spent on their behalf. Some have suggested this is due to children being “healthy and not needing much care,” a statement unsupported by the national pediatric mental health crisis, the annual respiratory RSV surges, and the significant access challenges for families needing pediatric specialty care across the country.
Through policy decisions, lawmakers have demonstrated pediatrics is a lower priority compared to the longstanding national focus on the health care of adults. This needs to change. We’ve called on congressional leaders to take action for pediatric resources before and will continue to do so. It’s time our country steps up on behalf of our future and supports pediatric health care in the way it deserves. Our future depends on it.
Mark Wietecha is CEO of the Children’s Hospital Association, representing over 200 children’s hospitals in their role as leading national advocates for children’s health in Washington, D.C., and across the country.