G'Day, Querida:

In response to your questions about US Pediatric visits...

The Am. Acad. of Pediatricians (with consent of the US Federal Gov't)
has established an 'immunization schedule' for children under 2 years of
age.  Getting these immunizations is a major reason for parents to take
their children to the physician. They are called 'well-child check-ups'.
If the family has health insurance or is poor enough to qualify for
Federal Health Care (Medicaid), then the checks and immunizations are
practically free.  Others would have to pay. I don't have the specific
immunizations by date at hand, but the scheduled checks are principally
at 2 wks post partum (first post-partum office check), 1 mo, 2 mo, 4 mo,
6 mo, 9 mo, 1 yr and 2 yr.  The immunizations are for diptheria,
rubella, measels, polio, hepatitis B,  mumps, and maybe something else.
Varicella is often available if parents choose, but may or may not be
covered by health insurance (varies by company).

These 'well-child' checks are in addition to any 'sick-visits' that may
be needed if child has diarrhea, ear infection, cold, etc.

There are many families, however, who for various reasons do not take
their kids to the MD for either 'well' or 'sick' visits.  Some don't
have the money.  Some don't have flexible enough time during the work
day to be able to leave work to take the child (or don't have access to
evening clinics to be able to do so).  Some parents are very fatalistic
and 'present-oriented' and so do not focus on preventive care (like well
checks or immunizations) and use medical care primarily through
emergency room services (which are very expensive and often the family
does not /cannot pay for the service).  Some are very good with home
care and only go to the physician if the child is truly sick.  Some
don't want the immunizations for the child (for various reasons) and so
don't go for any other preventive/proactive checks.

US Health care policy is to get children into a 'medical home' so that
their health can be monitored and so that parents can be given proactive
teaching and support to better care for their kids.  There was a lot of
research in the 1960s and 1970s that indicated that poverty and lack of
health care were big predictors of poor educational outcomes and
criminal activity (!).  Don't know if you see any similar outcomes in
Australia, especially among lower-income populations.

So, now the AAP is really getting on the bandwagon to get more kids into
preventive care situations through various venues -- schools,
'after-hours' clinics, even shopping centers.  Of course, this has the
potential to put more $$ into pediatrician pockets.  However, in the US,
peds are typically among the lowest paid MDs.  Also, 'medical home' can
also include Pediatric Nurse Practitioners, Physician's Assistants, and
other health care providers -- not just doctors.

If you want more info about 'medical homes', you can go to the AAP's
website and look for information on Healthy Tommorrows project:
<www.aap.org>

--Doraine Bailey, MA
Lexington, Kentucky

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