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A badly flawed system

A former president of the American Academy of Pediatrics says the current flu epidemic sweeping Colorado that’s responsible for the deaths of at least nine children underscores the need for massive reform of the state’s child health care system.Dr. Steve Berman, professor of pediatrics at the University of Colorado School of Medicine in Denver, says the state has the lowest childhood immunization rate in the country and a woefully inadequate system of childhood vaccine delivery.”I think in some ways this epidemic (the worst in the state in 20 years) is a mirror that we can now use to see the gaps that exist in our child health care system,” Berman says. “And we can choose to ignore them and hope we don’t have anymore major epidemics, or we can make a New Year’s resolution that we’re going to work on fixing these problems.”Those problems include the fact that Colorado has used parts of Medicaid and the Child Health Plan to build a flawed and piecemeal health care system, Berman says, adding Colorado and Montana have the country’s most restrictive pediatric public health insurance programs.Colorado is one of eight states that only enrolls children in its Medicaid program who are required by the federal government, he says, and one of only five states that still requires asset testing for all children. Further, Colorado is one of only nine states that still has eligibility for its Title XXI state child health insurance plan, called the Colorado Child Health Plan, set below 200 percent of the federal poverty level and is one of only six states that has a cap on enrollment in the state child insurance plan.All of these factors add up to major hurdles in immunizing one of the state’s most at-risk demographic groups.Berman urges increasing funding for county public health immunization clinics (especially critical in rural areas like Eagle County), implementing a statewide immunization registry that would have reminder/recall capacity, designating funds for vaccine for children who are insured but whose insurance does not cover the cost of vaccine, and adding financial incentives in both the private and the public health plans for immunizations.He is also pushing for increasing the number of Colorado children who have health insurance and improving their access to a primary care physician by ending Medicaid asset testing for children, removing the cap on the Colorado Child Health Plan, expanding eligibility to 200 percent of the federal poverty level, and increasing the participation of private physicians in Medicaid and the Child Health program. Currently, he says, participation by private physicians in those programs lags because doctors are reimbursed at a rate so low it doesn’t even cover their overhead costs.”When things are going well and we don’t have this kind of an epidemic, these kinds of child health issues don’t get on anyone’s radar screen,” Berman says. “It’s only when we have large numbers of children getting sick that we realize the system isn’t working as well as it should.”Uninsured or underinsured children put an enormous strain on community hospitals such as the Vail Valley Medical Center, Berman says, because instead of taking preventative measures as prescribed by a primary care physician, parents wait until their children are sick and then wind up taking them to the emergency room.The flu epidemic that has swept across Colorado and impacted Eagle County highlights the weak links in the system and should be studied to provide answers for the future, Berman says. He adds that infectious disease epidemiologists were not surprised by the severity of this season’s outbreak and warns that more serious epidemics are likely. But he does not go so far as some who have suggested a looming pandemic along the lines of a 1918 outbreak that killed 40 million people worldwide.”I don’t want to be a person who says the sky is falling,” Berman says. “Will the outbreak be as devastating as it was in 1918? I don’t think so, because our ability to manage epidemics and treat them are very different than they were in 1918.”


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