Hearing screening for all newborns and regular screenings External Link (PDF, 609 KB) for children and adolescents as recommended by their provider.Gonorrhea preventive medication for the eyes of all newborns.Fluoride varnish for all infants and children as soon as teeth are present.Fluoride supplements for children without fluoride in their water source.Dyslipidemia screening External Link (PDF, 609 MB) for all children once between 9 and 11 years and once between 17 and 21 years, and for children at higher risk of lipid disorders.Developmental screening for children under age 3.Depression screening for adolescents beginning routinely at age 12.Blood pressure screening for children: Age 0 to 11 months, 1 to 4 years , 5 to 10 years, 11 to 14 years, 15 to 17 years.Bilirubin concentration screening External Link (PDF, 609 KB) for newborns.Behavioral assessments for children: Age 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.Autism screening for children at 18 and 24 months.Alcohol, tobacco, and drug use assessments for adolescents.With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. The amount you pay for covered health care services before your insurance plan starts to pay. Check if you qualify for a Special Enrollment Period.In addition, the percentage of non-wellness visits with associated preventive services increased approximately 60%, from 1.8% in 2006 to 3.7% in 2018 (coefficient on linear time trend: 0.09 percentage points 95% CI, 0.03-0.15 P = .005). The percentage of wellness visits with an associated out-of-pocket cost declined from 54.2% in 2010 (the year that the ACA was passed) to 14.5% in 2018 (coefficient on linear time trend: −5.63 percentage points 95% CI −6.96 to −4.31 P < .001) ( Figure, C). Older children had office visits or outpatient care without a wellness visit at higher rates than younger children during the study period ( Figure, A). The volume and relative share of total visits per child (coefficient on linear time trend: 0.01 visits 95% CI, 0.01-0.02 P = .03) and wellness visits per child (coefficient on linear time trend: 0.02 visits 95% CI, 0.01-0.02 P < .001) remained stable over time ( Figure, B).
The proportion of children with at least 1 office or outpatient visit and without a wellness visit declined from 39.3% in 2006 to 29.0% by 2018 (coefficient on linear time trend: −0.79 percentage points 95% CI, −1.11 to −0.47 P < .001) ( Figure, A). The sample consists of 88 863 727 person-years from privately insured children in 48 states, with a total of 371 573 184 visits across the study period from 2006 through 2018 ( Table). Data were analyzed from June 10, 2020, to January 15, 2021, using SAS, version 9.4 (SAS Institute, Inc) and Stata, version 16 (StataCorp). P < .05 was considered to be statistically significant, all P values were 2-sided. We plotted the trends over time and tested for significance using linear regression. We examined trends in visit volumes to ensure that compositional changes did not explain the findings and assessed the delivery of preventive services during non-wellness visits. 4 Diagnosis codes from the International Classification of Diseases, Ninth Revision (visits before October 2015) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (visits in October 2015 and after) and Current Procedural Terminology and Healthcare Common Procedure Coding System codes used to identify preventive services were obtained from the Centers for Disease Control and Prevention and were supplemented with coding guidelines from major insurers. We stratified the sample by 2 age groups (0 to 5 years and 6 to 17 years) because these groups have a different recommended frequency of visits for wellness and other preventive services. We focused on 2 outcomes: the proportion of children who had an office or outpatient visit without a wellness visit and the proportion of wellness visits resulting in an out-of-pocket cost, which were calculated annually during the study period. We used health insurance claims from 2006 through 2018 from children aged 0 to 17 years with full-year coverage each year claims were obtained from the IBM MarketScan Commercial Claims and Encounters Database. We followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE) reporting guideline. This cross-sectional study was deemed exempt from review, and the requirement for patient written informed consent was waived by the Boston University Institutional Review Board because deidentified data were used.
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