Complex Care for Kids Is Drying Up
A new report by the state Senate Office of Research says that California’s sickest, most vulnerable children are finding it increasingly difficult to get the medical care they need. I see the results of our state’s neglected medical policies every day.
I am a pediatric plastic surgeon at Children’s Hospital Los Angeles. For the past 17 years, I have treated babies born with severe facial deformities as well as children whose features have been distorted by birthmarks, cancer, burns or accidents.
Most of the complicated young patients seen at pediatric hospitals in this state rely on California Children’s Services to pay their medical bills. The CCS program covers children up to 21 years of age with complex conditions that are either life-threatening or debilitating. It helps low-income families with no medical coverage as well as middle-class families who otherwise would drown in debt trying to pay for their children’s medical expenses.
Twenty years ago, CCS was one of the nation’s model programs. It helped California attract some of the country’s best pediatric specialists. Our children with cancer, heart disease, kidney failure, cystic fibrosis, juvenile arthritis, hemophilia, craniofacial deformities and other severe conditions were able to obtain timely, state-of-the-art care by pediatric specialists for their specific condition.
Unfortunately, CCS has been severely underfunded for years. There has been virtually no increase in CCS physician reimbursement since 1982. The current reimbursement structure is so low that it is destroying the future of children’s health care in California. A pediatric cancer specialist who spends more than an hour explaining various treatment options to the parent of a child with leukemia will receive an average of $18. CCS reimbursement to its pediatric specialists is lower than any of the other 49 states’ programs. It pays about half the amount adult specialists would receive for the same service from Medicare, a program that covers individuals over 65.
The low reimbursement affects all of our children’s ability to obtain care. Pediatric specialists, frustrated by low pay, long hours and high costs, are leaving California to practice in states with better reimbursement and a lower cost of living. With fewer experienced specialists, all children, even those with insurance, are finding access to pediatric specialty care more difficult as the remaining physicians must shoulder a larger patient load. As a result, waiting times for appointments and procedures have increased alarmingly.
Last summer, there were 26 full-time surgeons at Children’s Hospital in Los Angeles. In the last 12 months, seven of these surgeons have left the hospital. Five moved to facilities out of state; the two others remain in California but are no longer seeing CCS children. More surgeons left this year than the number who left in the last 10 years. The same scenario is taking place at other pediatric centers throughout the state.
Low reimbursement has made it harder and harder to recruit qualified children’s specialists to California. Positions at California’s pediatric hospitals that were once competitively sought are now empty or taking years to fill. Frequently, those physicians who do take positions have just completed their training and lack the experience or expertise of the physicians they were hired to replace.
It’s painful to watch California’s once-stellar CCS program collapse from years of fiscal neglect. As a physician who cares for our state’s youngest citizens, I am saddened that this problem exists in the wealthiest state in the country.
I am baffled that the governor either does not understand the crisis or is unwilling to take decisive action.
Very little taxpayer expense is needed to restore the health to the CCS program. Both the state Senate and Assembly had passed a budget that included $23 million to raise the level of CCS reimbursement to that received by pediatric specialists in such states as Mississippi, Georgia, North Carolina, Tennessee and Arkansas. Unfortunately Gov. Gray Davis proposed a much smaller increase of $4 million in his May budget revision. If the governor’s version of the budget prevails, an $18 reimbursement for an office visit to care for a child with cancer will increase by only $2.60. The originally proposed $23-million increase represents less than one-fifth of 1% of this year’s projected $12.8-billion budget surplus.
Our children deserve the best and most timely care. California needs to be able to keep and attract pediatric specialists. One day, it may be your child who needs the help.
