THE PEDIATRICIAN AND THE PUBLIC

1. Under a comprehensive system of prepaid medical care (HIP), the services of qualified pediatricians, as well as of laboratories, clinical specialists, and visiting nurses have been made available to children without any extra charges to prevent their full utilization. 2. The 63,500 children under 15 years of age enrolled in HIP on March 1, 1951, constituted 24.5% of the total insured population on that date (259,170). Of these 36.0% were under 5 years, 34.6% between 5 and 9 years and 29.4% were aged 10 to 14. 3. Of the 5,500 children born into HIP since it was established four years ago, 90% were delivered by qualified obstetricians. 4. Since 1949 all infants are routinely under the care of a qualified pediatrician at least until the end of the first year of life, 48.5% of HIP children are cared for by pediatricians to school age, and almost 32% receive all their routine care from pediatricians to the age of puberty. 5. Of the 62 qualified pediatricians on the staffs of the 30 HIP medical groups, 40 are diplomates of the American Board of Pediatrics. 6. HIP has one pediatrician for each 1,025 enrolled children under 15. This is 2½ times the proportionate number available to children living in the larger urban centers of New York State, assuming that all of the pediatricians in the State are located in such areas. 7. In medical groups in which pediatricians provide child care to puberty, the proportion of home visiting is high as compared with their medical center, office, and hospital services; 34% of their services are home calls, 59% medical center or office calls, and 7% are rendered in the hospital. The pediatricians who serve chiefly as consultants do much less home visiting (8.4% of their total services) but provide a much higher percentage of medical center and office services (79.3%) and also a higher proportion (12.3%) of their services in the hospital. 8. Children under one year average 13.1 physicians' services per year, many of a purely preventive nature. Age-specific utilization rates have been computed for the 1948 experience on 500,000 physician services and are reported in this paper. 9. HIP's neonatal mortality rate was about 9 per 1,000 live births, whereas the rate of New York City as a whole during the same year was 20 per 1,000, of New York State 20.7 per 1,000, and of the country about 25 per 1,000. 10. An analysis is reported in this paper of HIP's experience with pediatric surgery during the last six months of 1949, which included 1,528 surgical procedures in relation to 27,925 enrollee years of children. 11. Although consultant services of psychiatrists can be provided under a comprehensive system of prepaid group practice, the pediatricians of the medical group must continue to carry the responsibility, as in any other system of medical care, for that large part of medical practice which is concerned with the behavior and emotional problems of childhood. In comprehensive group practice it has therefore been found desirable for the pediatrician to relieve the family physician of the routine care of young children in the family, at least during infancy and the preschool period.