More Injury Care for Young People Anticipated

By Jennifer Larson, contributor

August 14, 2013 - Children and young adults with health insurance coverage tend to seek out care for mild and moderate injuries. But it often takes an injury as serious as a broken bone to get a young person without health insurance to seek out medical care.

Flaura Winston: More young people will seek injury care once insured per ACA.
Flaura Winston, MD, PhD, recently co-authored a study that predicted more young people will seek out injury care once they receive insurance per the Affordable Care Act.

“If you don’t have health insurance, and it’s not eminently life threatening, you might stick it out,” pediatrician Flaura Winston, MD, explained. Yet lack of proper injury care can have long-term, negative repercussions. 

The practice of “sticking it out” could change, however, as more young people receive health insurance coverage through implementation of the Affordable Care Act (ACA).  Now, a new study has examined the impact these changes are likely to have on hospital emergency departments and outpatient care.

The impact of more insured youth

A team of researchers led by Winston from The Center for Injury Research and Prevention at The Children’s Hospital of Philadelphia (CHOP) recently examined data on injuries and care for young people 26 years and younger from the 2008 National Health Interview Survey. Their results, published in Clinical Pediatrics in July, showed that the healthcare systems and providers can anticipate a 6.1 percent increase in medically attended injuries, once all uninsured youth receive health insurance coverage.  

“With insurance, families who previously attempted to self-treat relatively serious sprains and lacerations would likely then seek professional care,” they wrote, adding, “The majority of the expected increase will involve the provision of outpatient care, but a substantial portion of the newly treated injuries will involve ED and hospital care.”

The researchers also noted that they expect the prevention of “longer term morbidity from inadequately treated injuries” will result in eventual cost savings. 

But to provide that kind of appropriate care, the healthcare system needs to be ready. Often, in the event of seemingly mild injuries, parents with insurance may opt to take children in for an office visit, rather than braving the waiting room at the emergency department or pediatric trauma center. So healthcare systems will need to make sure they have enough general and pediatric providers who are appropriately trained in treating injuries and trauma.

And investing in injury prevention should prove to be cost-effective in the long run, said Winston.

“Do you want to pay for it by giving trauma care or long-term rehab in a much more costly way that will produce outcomes that are not as great, or do you want to spend a little bit of money up front?” she asked. 

Lynn Hass: Despite more injury care cases, providers must improve quality while monitoring costs
Lynn Haas, RN, MSN, CNP, believes that health care providers must strive to continually improve the quality of care they deliver, while monitoring clinical outcomes and cost.

Pediatric Trauma Society President Lynn Haas, MSN, RN, CNP, agreed that more coverage for those currently uninsured will probably save money.

“The caveat to this is that healthcare providers must continue their journey on improving quality care, while monitoring clinical outcomes and cost,” she said. “For the Pediatric Trauma Society and those healthcare providers that provide pediatric injury care, it is our responsibility to develop clinical care guidelines, whether best practice or evidence-based, that can be distributed across the country.  It is also our responsibility to share knowledge with the primary care physician and others so that costs can be kept in check while continuing to provide quality care.  If these actions occur in conjunction with the Affordable Care Act, the outcome will be positive.”


The researchers outlined a series of recommendations that could ensure that level of care for children and young adults.  “Injury prevention through widespread implementation of proven strategies should be considered the highest priority to contain costs,” they wrote.

The recommendations include allocating more resources for implementation of the Centers for Disease Control and Prevention’s (CDC’s) National Action Plan on Childhood Injury and preserving programs that give access to high quality pediatric care, such as the Emergency Medical Services for Children (EMSC) and the Children’s Hospitals Graduate Medical Education (CHGME) programs.

“Children are not small adults, and they need care that is developmentally appropriate,” said Winston. “Are we ready with our triage protocols and our training?”

Another recommendation was allowing safety devices like car seats and bike helmets to be categorized as durable medical equipment. Currently, parents are the ones who pay for the infant seats in which to transport their new babies home from the hospital, although occasionally hospital foundations pay for seats for indigent families. If vaccines and other strategies that are proven to be effective at preventing disease can be covered, why can’t devices that are proven to reduce injuries be covered as well, asked Winston. 

Haas supports the recommendation, noting that a car seat can’t be re-used after a motor vehicle crash. “Many families don’t have the resources to go out and buy a couple more of those,” particularly if they have multiple children, she said. 

Haas hopes the rest of the recommendations are also given a high priority.

“As healthcare providers move beyond the hospital walls toward management of population health in their communities, this aspect of injury prevention takes on much greater meaning,” she said. “It will be essential to prevent children, adolescents and young adults from being injured and requiring costly medical care. This will be our most effective method of reducing injury costs, treatments and hospitalizations.”

Said Winston, “Shouldn’t we give kids the best care that we can? They’re our future. It’s just making sure that they get good care and it’s consistent across the country--and that it’s evidence-based.”


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