• Report
  • July 16, 2018

Implications of adult network adequacy standards on children’s access to pediatric specialty care

A June 2018 analysis, by children’s hospital and Children’s Hospital Association (CHA) researchers examined the impact of narrow networks and the use of adult-focused network adequacy standards on children’s access to specialty pediatric care. The study found that nearly half of pediatric specialty hospitalizations took place outside of those distance standards. The study was published in the June issue of Health Affairs. 

An earlier CHA preliminary analysis of the impact of adult network adequacy standards on children’s access to care had similar findings. The 2014 analysis found that only 49.9 percent of children ages 0-19 would have access to an acute care children’s hospital when commonly used adult distance metrics to assess network adequacy are applied to those hospitals. 

This analysis also examined the distribution of pediatric health care services, care delivery, and pediatric care utilization. Children’s hospitals in the study: 

  • Provided, on average, more than six-fold the number of selected pediatric services than seen in non-children’s hospitals, and had more than 25-fold the number of pediatric-designated beds.
  • Provided more than 80 percent of inpatient care to pediatric patients in need of cardiac surgery, bone marrow transplants and solid organ transplants, and more than 50 percent of the inpatient care to children in need of rheumatology services, otolaryngology surgery, surgical neuroscience services, oncology care, and six additional specialties.

These findings demonstrate that adult distance standards should not be used to assess a provider network’s adequacy in relation to pediatric specialty care given the regional nature of that care, particularly tertiary and quaternary pediatric care. In addition, the CHA preliminary analysis shows that children’s hospitals, unlike other hospitals, have the clinical expertise and capacity necessary to ensure children receive appropriate and high quality care that meets their unique needs.

CHA Contacts: Jan Kaplan, (202) 753-5384 or Alex Rothenburger, (202) 753-5370