Pediatric preventive care: What determines whether patients are counseled about health behaviors and injury prevention?

Child health problems caused or exacerbated by health behaviors such as unhealthy eating, lack of exercise, and parental smoking have been growing, and injuries remain a leading cause of medical spending for children, yet many children in the United States do not receive important advice about health behaviors and injury prevention from their health providers. We use a sample of children in the MEPS from 2001-2003 to examine what factors affect whether children aged 3-17 receive counseling about diet and exercise, the harmful effects of parental smoking in the home, proper safety restraints in a car, and use of a helmet while riding a bicycle from their pediatric provider. We find that for low-income children, insurance status has an important effect that operates through the margin of whether children have any preventive care visits. For all children, obtaining preventive care from a pediatrician rather than another provider increases the chances of receiving counsel in these areas. Regardless of a child's characteristics, many do not receive advice in these areas. This is true even among children who have the recommended number of preventive care visits and among children who would especially benefit from the advice, such as children who are overweight. A number of policy changes could be considered to increase receipt of physician counseling for children during preventive care visits, including increasing insurance coverage for low-income children, improving reimbursement for email and phone communication with patients, and tying reimbursement for preventive care to visit length and content.