Differences in the Receipt of Low-Value Services Between Publicly and Privately Insured Children

• Published in: Pediatrics (Evanston) 2020-02, Vol.145 (2), p.1
• Main Authors: Chua, Kao-Ping, Schwartz, Aaron L, Volerman, Anna, Conti, Rena M, Huang, Elbert S
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Children; Children's Health Insurance Program - standards; Children's Health Insurance Program - statistics & numerical data; Cross-Sectional Studies; Diagnostic tests; Diagnostic Tests, Routine - standards; Diagnostic Tests, Routine - statistics & numerical data; Female; Humans; Infant; Infant, Newborn; Insurance Claim Review - statistics & numerical data; Male; Medicaid - standards; Medicaid - statistics & numerical data; Pediatrics; Prescription Drugs - standards; Private Sector - standards; Private Sector - statistics & numerical data; Public Sector - standards; Public Sector - statistics & numerical data; United States; Value-Based Health Insurance - statistics & numerical data
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2019-2325

Children frequently receive low-value services that do not improve health, but it is unknown whether the receipt of these services differs between publicly and privately insured children. We analyzed 2013-2014 Medicaid Analytic eXtract and IBM MarketScan Commercial Claims and Encounters databases. Using 20 measures of low-value care (6 diagnostic testing measures, 5 imaging measures, and 9 prescription drug measures), we compared the proportion of publicly and privately insured children in 12 states who received low-value services at least once or twice in 2014; the proportion of publicly and privately insured children who received low-value diagnostic tests, imaging tests, and prescription drugs at least once; and the proportion of publicly and privately insured children eligible for each measure who received the service at least once. Among 6 951 556 publicly insured children and 1 647 946 privately insured children, respectively, 11.0% and 8.9% received low-value services at least once, 3.9% and 2.8% received low-value services at least twice, 3.2% and 3.8% received low-value diagnostic tests at least once, 0.4% and 0.4% received low-value imaging tests at least once, and 8.4% and 5.5% received low-value prescription drug services at least once. Differences in the proportion of eligible children receiving each service were typically small (median difference among 20 measures, public minus private: +0.3 percentage points). In 2014, 1 in 9 publicly insured and 1 in 11 privately insured children received low-value services. Differences between populations were modest overall, suggesting that wasteful care is not highly associated with payer type. Efforts to reduce this care should target all populations regardless of payer mix.