MELVILLE, N.Y. – Children are not faring well in the health care system, and most are not coming anywhere near the quality of care afforded adults, a team of researchers reports today in the largest analysis of its kind.

“The study builds on a body of work” that initially explored whether adults were receiving appropriate medical care, said Elizabeth McGlynn of the RAND Corp. think tank. A researcher for the report, McGlynn said it is clear children do not fare as well as adults in receiving the care they need.

“No one anywhere is immune from poor-quality care,” McGlynn said.

The study examined medical records of 1,536 children nationwide. More than 80 percent had private health insurance, usually a marker for appropriate care.

But findings revealed that kids nationwide, regardless of insurance status, are receiving only 46 percent of the care they should be getting in doctors’ offices, emergency rooms and hospitals. In the earlier study, RAND researchers found adults received 55 percent of recommended medical and preventive treatment.

The new report, which appears in Thursday’s New England Journal of Medicine, found that children do not always receive appropriate care for acute medical conditions such as asthma and are even more unlikely to receive preventive care to stave off future health problems, such as diabetes, high blood pressure and heart disease.

“The majority of these children were from white middle- to upper-middle-class families with private health insurance,” said Dr. Rita Mangione-Smith, a co-author of the report and a pediatrician in Seattle. “These are the kids most people assume are getting excellent care in this country, and unfortunately they are not.”

The researchers found, for example, that only 19 percent of seriously ill infants with fevers taken to doctors had the correct laboratory tests to determine the underlying ailment. Only 44 percent of children with asthma, the study found, were on the right medication.

“How can we appropriately treat an infant if we don’t test?” Mangione-Smith asked Wednesday.

The research also discovered babies aren’t receiving routine checks of their height and weight to ensure proper growth. Some youngsters aren’t receiving all of their recommended vaccinations. And children are not being appropriately screened for anemia, a marker for learning disorders.


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