The pediatric bed shortage will remain — we need to support pediatric healthcare the way it deserves

Parents don’t have to look far for alarming news that children’s hospitals are experiencing bed shortages and long wait times to see pediatric specialists as the wave of flu and respiratory syncytial virus (RSV) worsens. According to the CDC, one-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 respiratory infections in children and provide additional funding and resources to cover care capacity. We are grateful that the Biden administration has clarified that flexibility given to hospital systems during COVID-19 to ease certain staffing requirements also applies to RSV and influenza. However, more work needs to be done if we are to get to the root of the problem.

Even before the COVID pandemic, pediatric programs at community hospitals had been in decline for many years. Specialists who care for basic health needs such as mental health, adolescent medicine and neurology have also been in short supply for a long time. This shortage has developed despite increasing demand for pediatric health care for our nation’s 76 million children. There is no mystery why supply has not kept up with demand.

Simply put, there is a devastating lack of financial prioritization in our nation’s health care system. Most care for children from pediatric hospitals, pediatricians and family physicians is reimbursed at lower rates than care for adults. The training of pediatricians is funded at lower levels than doctors trained to care for adults. Pediatricians make less money than their physician colleagues focused on adult care, even though they accumulate the same medical education debt. Without the substantial financial support of private commercial insurance and community philanthropy for children’s hospitals to offset low Medicaid reimbursement, the pediatric hospital industry in the United States would be unsustainable as we know it.

All hospitals and aspiring physicians faced with the choice between adult versus pediatric healthcare programs and practices are encouraged to choose the former. In doing so, they make 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 that values ​​adult health care and providers at comparatively higher levels.

The necessary solutions are well known and simple:

Reimbursement of pediatric health care services—physical and mental—in Medicaid at comparable levels paid by Medicare for health care for adults. Medicaid is the primary insurance program for children, covering more than 40 million children. Medicare is the primary payer program for seniors, covering over 50 million adults. Continuing to pay for Medicare elder care at higher levels strengthens providers’ incentives to focus on the elderly.

Invest in the training of doctors who care for children at a comparable amount given to doctors who focus 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 cost levels as training physicians focused on adult care. Despite similar costs, the Pediatric CHGME program is funded at half the amount of the Graduate Medical Education, or GME, program, supporting the training of all other U.S. residents. Continuing to fund CHGME at much lower levels than the GME program weakens the pediatric workforce by placing a greater financial burden on the training process. Without changes, we can expect both hospitals providing clinical programs and future physicians making career choices that will continue to prioritize their adult-focused opportunities over pediatrics.

The main challenge in maintaining a robust health care delivery system for children – from primary care pediatricians to advanced care at children’s hospitals – is financial. Federal health care costs for an adult are much higher than for a child. Although children make up 22 percent of the US population, a much smaller portion of the federal health care budget is spent on them. Some suggest this is because the children are “healthy and don’t need a lot of care,” a claim not supported by the national pediatric mental health crisis, annual respiratory RSV spikes, and significant access challenges for families. in need of pediatric special care across the country.

Through policy decisions, lawmakers have shown that pediatrics is a lower priority than the longstanding national focus on adult health care. This has to change. We have called on congressional leaders to act on pediatric resources before and will continue to do so. It’s time for our country to step up for our future and support pediatric health care the way it deserves. Our future depends on it.

Mark Vietecha is the CEO of Children’s Hospital Associationrepresenting over 200 children’s hospitals in their role as leading national advocates for children’s health in Washington, DC, and across the country.

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