Profile of Pediatric Visits - aap.org

1 Profile of Pediatric Visits Annualized Estimates by Source of Payment Patient Age Physician Specialty Well vs Sick Visit Office Setting Practice Ownership Physician Employment Status &. Geopgraphic Location 2004-2007. Annualized Estimates Visits to Office-based Physicians vs General Dentists by Infants and One-year-olds 2004-2007. Updated April 2010. Send questions and comments about this report to Suk-fong S Tang, PhD, Senior Research Analyst, Department of Practice, American Academy of Pediatrics, Elk Grove Village, Illinois Data Highlights: Infants, children and young adults through age Almost two-thirds of all Pediatric office Visits 21 account for 30% of the US population, and (65%) are provided by physician owners of the only 12% of total health care payment. practice. The remainder one-third (35%) are provided by employee or contractor After private health insurance, Medicaid and physicians.

2 SCHIP programs are the largest source of payment for Pediatric (through age 21) health Only 2% of infants and one-year olds visit any care, followed by family sources. Together, general dentist during the year. The great these sources cover 92% of children's health majority (87%, or million) visited office- care expenses, paying 48%, 24% and 20% of based physicians but not dentists in a year's total cost, respectively. time. The number of physician office Visits outnumber Visits to general dentists 190 folds Preventive Visits account for 29% of all Visits for this age group. by infants, children and young adults through age 21, and over half (52%) of all Visits by Nationally, office Visits provided by general infants. Pediatricians provide 84% of all well pediatricians outnumber Visits provided by Visits and 76% of all sick Visits to infants and other primary care physicians by more than 2- children under age 6, compared to 44% of well fold (56% vs 25% of all Visits ) for the 0-21.

3 Visits and 35% of sick Visits to adolescents. population. There is, however, considerable Overall, pediatricians provide 66% of all well geographic variation, by region and by Visits and 52% of all sick Visits for the age 0 metropolitan area classification. through 21 population. 87% of all Pediatric office Visits are provided in private solo or group practice, with the remainder provided in health centers, clinics, HMOs and other settings. 79% of all Pediatric Sources: AAP analysis of 2004-2007 Medical Expenditure Panel Survey and 2004-2007 National Ambulatory Care Survey. office Visits are provided in physician or physician-group owned settings. Content Figure 1 & Table 1. Health Care Provider Payment for Children and Adults, by Table 7. Pediatric Office Visits by Physician Source of Payment, 2004-2007 Specialty by Type of Practice Annual Average Ownership, 2004-2007 Annual Average Figure 2 & Table 2.

4 Pediatric Office Visits by Type of Visit by Patient Age, 2004- Table 8. Pediatric Office Visits by Physician 2007 Annual Average Specialty by Physician Employment Status, 2004-2007 Annual Average Table 3. Pediatric Office Visits by Physician Specialty by Patient Age, 2004-2007 Table 9. Number and Proportion of Infants and Annual Average One-year-olds with Visits to Office- based Physicians vs General Dentists, Figure 3 & Table 4. Well-child and Sick Visit 2004-2007 annual average by Physician Specialty by Patient Age Group, 2004-2007 Annual Table 10. Frequency of Visits to Office-based Average Physicians vs General Dentists by Infants and 0ne-year-olds, 2004-2007. Table 5. Pediatric Office Visits by Physician annual average Specialty by Source of Payment, 2004-2007 Annual Average Table 11. Pediatric Office Visits by Region by Metropolitan Statistical Area Table 6.

5 Pediatric Office Visits by Physician Classification, 2004-2007 Annual Specialty by Type of Office Setting, Average 2004-2007 Annual Average Figure 1. Health Care Provider Payment for Children and Adults, by Source of Payment, 2004-2007 Annual Average Ages 0 through 21 Age 22 and Older (Payment: $117B, 12% of Total) (Payment: $883B, 88% of Total). Private Insurance Medicare Medicaid/SCHIP Self/Family Other Source: AAP analysis of 2004 to 2007 Medical Expenditure Panel Survey Table 1. Health Care Provider Payment by Source of Payment by Age Group, 2004-2007 Annual Average Source of Payment All persons Ages 0 - 21 Over Age 21. Population (millions) Row% Total Provider Payment ($billions) $ $ $ Row% Col% Total Amount Paid by Private Insurance $ $ $ Row% Col% Total Amount Paid by Medicare $ $ $ Row% Col% Total Amount Paid by Medicaid/SCHIP $ $ $ Row% Col% Total Amount Paid by Self/Family $ $ $ Row% Col% Total Amount Paid by Other Source (military insurance, worker's comp and other sources) $ $ $ Row% Col% Note: Percents may not sum to 100% due to rounding.

6 Source: AAP analysis of 2000 to 2004 Medical Expenditure Panel Survey. Figure 2. Pediatric Office Visits by Type of Visit by Patient Age, 2004-2007 Annual Average 35,000. Number of Visits (thousands). 30,000. 25,000. Well Visit Sick Visit 20,000. 15,000 10,000. 5,000. 0. 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21. Age Source: AAP analysis of 2004 to 2007 National Ambulatory Medical Care Survey Table 2. Pediatric Office Visits by Type of Visit by Patient Age, 2004-2007 Annual Average (Number of Visits in Thousands). #Total #Well #Sick Age Visits Col% Visits Row%* Col% Visits Row%* Col%. Through 21 210, 61, 146, 0 30, 15, 14, 1 19, 7, 11, 2 11, 2, 8, 3 10, 2, 7, 4 10, 2, 7, 5 9, 2, 7, 6 8, 1, 7, 7 7, 1, 6, 8 6, 1, 5, 9 6, 1, 5, 10 6, 1, 5, 11 7, 1, 5, 12 7, 1, 5, 13 7, 1, 6, 14 8, 1, 6, 15 7, 1, 6, 16 8, 1, 6, 17 8, 2, 6, 18 7, 2, 5, 19 6, 1, 4, 20 6, 1, 4, 21 6, 2, 4, *Row percents do not sum to 100% due to approximately missing data on type of visit.

7 Source: AAP analysis of 2004-2007 National Ambulatory Care Survey. Includes Visits by patients under age 22. Table 3. Pediatric Office Visits by Physician Specialty by Patient Age, 2004-2007 Annual Average (Number of Visits in Thousands). # Visits to # Visits to Other # Visits to # Visits to Pediatric Primary Care # Visits to All General Sub- Physician Other Age Physicians Row% Col% Pediatrician Row% Col% specialist Row% Col% ** Row% Col% Specialist Row% Col%. Through 21 210, 117, 5, 51, 35, 0 30, 24, 4, 1 19, 14, 2, 1, 2 11, 8, 1, 3 10, 7, 1, 4 10, 7, 1, 1, 5 9, 6, 1, 1, 6 8, 5, 1, 1, 7 7, 5, 1, 1, 8 6, 4, 1, 1, 9 6, 4, 1, 1, 10 6, 3, 1, 1, 11 7, 4, 1, 1, 12 7, 3, 1, 1, 13 7, 4, 1, 1, 14 8, 3, 2, 1, 15 7, 2, ~ 2, 2, 16 8, 3, ~ 2, 2, 17 8, 2, ~ 3, 2, 18 7, 1, ~ 3, 2, 19 6, ~ ~ 3, 2, 20 6, ~ ~ 4, 1, 21 6, ~ ~ 4, 1, **Other Primary Care Physicians are defined as family physicians, general practitioners, internists and obstetricians/gynecologists for the purpose of this report.

8 ~ Unstable estimate due to low reliability associated with small sample. Source: AAP analysis of 2004-2007 National Ambulatory Medical Care Survey. Includes Visits by patients under age 22. Figure 3. Well-Child and Sick Visits by Provider Specialty by Patient Age Group, 2004-2007 Annual Average General Pediatrician Pediatric Subspecialist Other Primary Care Physcian Other Specialist Well Visit Sick Visit 100%. 90%. Proportion of of Visits 80% 70% 60%. 50% 40%. 30% 20%. 10%. 0%. 11. 11. 5. 5. 18. 21. 18. 21. e e h h Ag Ag gh gh gh gh ug ug ou ou ou ou h h ro ro ug ug hr hr hr hr th th ro ro 2t 9t 2t 9t 6. 6. Th Th 1. 1. 1. 1. es es es es es es Ag Ag Ag Ag Ag Ag Note: Both (a) well and sick visit estimates for the age 19-21 group to general and subspecialist pediatricians, and (b) well visit estimates for Pediatric subspecialists, are unstable due to small sample size.

9 Interpret with caution. Source: AAP analysis of 2004 to 2007 National Ambulatory Medical Care Survey Table 4. Well-child and Sick Visit by Physician Specialty by Patient Age Group, 2004-2007 Annual Average (Number of Visits in Thousands). # Visits to # Visits to Other # Visits to # Visits to General Pediatric Primary Care Other Age Group Pediatrician Row% Subspecialist Row% Physician** Row% Specialist Row%. Well-child Visit Total 40, 17, 2, Through Age 5 28, ~ 5, Ages 6 through 11 7, ~ 2, Ages 12 through 18 4, ~ 5, Ages 19 through 21 ~ ~ 5, Sick Visit Total 76, 4, 33, 32, Through Age 5 40, 1, 7, 5, Ages 6 through 11 22, 1, 7, 8, Ages 12 through 18 11, 11, 12, Ages 19 through 21 ~ ~ 6, 5, **Other Primary Care Physicians are defined as family physicians, general practitioners, internists and obstetricians/gynecologists for the purpose of this report. ~ Unstable estimate due to low reliability associated with small sample.

10 Source: AAP analysis of 2004-2007 National Ambulatory Medical Care Survey. Includes Visits by patients under age 22. Table 5. Pediatric Office Visits by Physician Specialty by Source of Payment, 2004-2007 Annual Average (Number of Visits in Thousands). # Visits to Other Primary # Visits to Primary Expected # Visits to # Visits to Pediatric Care # Visits to Source of All General Sub- Physician Other Payment Physicians Row% Col% Pediatrician Row% Col% specialist Row% Col% ** Row% Col% Specialist Row% Col%. Total 210, 117, 5, 51, 35, Private insurance 131, 75, 2, 28, 23, Medicare 2, 1, Medicaid 56, 33, 1, 15, 6, Worker's compensation ~ ~ ~ ~. Self-pay 6, 2, 2, 1, No charge ~ ~ ~ ~. Other 4, 1, ~ 1, Total 210, 117, 5, 51, 35, Note: Column percents may not sum to 100% due to missing data on primary expected source of payment. **Other Primary Care Physicians are defined as family physicians, general practitioners, internists and obstetricians/gynecologists for the purpose of this report.