You Get What You Pay For


An article in yesterday’s Los Angeles Times titled “Pediatric care shrinks across California” shows that as funding for pediatric care has decreased in California, so has the number of hospitals that are willing to provide pediatric care.

California’s reimbursement rates for children’s health care is ranked last in the country. It shouldn’t come as a shock that more and more hospitals are focusing on treating adults – because they get paid more for doing so.

In the last decade, the number of children in California has increased, but the number of inpatient pediatric beds dropped by 19% – more than 800 beds. Sixty five hospitals either eliminated their children’s units or shut down altogether. The article states that “most counties north of Sacramento now lack even a single dedicated pediatric bed.”

What happens when your child becomes severely ill and there are no pediatric ICU beds within several hundred miles?

LA County – USC Medical Center dropped from 135 pediatric beds 2 years ago to just 55 beds now. There is now a question as to whether the LA County will be able to provide care for the 7,000 foster children treated annually at the Medical Center.

The cuts may also affect pediatric training programs. The hospital now reportedly has the smallest university-affiliated pediatrics teaching program in the nation. The LA County Supervisor states that the program will become “noncompetitive to intern applicants except the poor performers from low-ranked medical schools.”

One parent who brought her child to a hospital emergency department with no licensed pediatric beds describes waiting for 11 hours for her son to be seen and then noted that the medical providers “seemed unaccustomed to treating infants and had difficulty inserting an IV.”

A Stanford children’s health policy researcher was quoted as saying “In California, things are a mess”.

Once the balance billing issue takes full effect and emergency physicians are paid even less for the care they provide, I predict that medical care in California will be an even “bigger” mess.

Is everyone starting to get the idea that you get what you pay for?


  1. This is not just in California. SCHIP has resulted in many parents dropping conventional insurance for the Medicaid reimbursing programs. With the lower revenue and higher costs in the practice of medicine, SCHIP which was hoped to increase access for pediatric care seems to be backfiring.

  2. Wait a minute. Cali is tort reform nirvana with the most draconian reforms in the country. You physicians said that was the key to attracting you and making a state desirable. A place with great “reform” is where you said you were all fleeing to and that place would have all the trauma docs it could handle even out in the sticks! Was that not true? Were those just empty political promises designed to help your insurer while the patient got nothing back? Say it ain’t so, doc.

    • Ahhhh. Another post with inflammatory rhetoric and not one single citation. A judge would laugh at a legal brief of similar qualities.
      Actually, Texas is more of a modern example of “tort reform nirvana.”
      Now that there are caps and plaintiffs attorneys can’t make those 7 figure contingency fees, all the altruistic, justice-oriented plaintiffs attorneys stopped taking cases. According to the cited article, the plaintiff attorneys believe that only the gainfully employed deserve representation. Elderly and “stay at home moms” who are victims of malpractice get the shaft – no one will take their cases.
      Kind of ironic that plaintiff attorneys expect medical professionals and hospitals to provide limitless care to everyone regardless of costs, but how plaintiff attorneys think it is entirely appropriate to close up shop overnight when megaverdicts dry up, isn’t it?
      Who’s there to represent the injured elderly and indigent patients in Texas during their time of need??? The injured patients suddenly aren’t worth the attorneys’ time any more. Some justice.
      Don’t throw stones when living in a glass house, Matt.

      • Do you need a citation for MICRA in California? Really? I thought that was common knowledge among physicians?

        What’s so nirvanaesque about Texas? Doctor growth that doesn’t keep pace with the population growth? Strong insurance company lobbyists who stick it to the elderly and kids? I guess everyone has a different idea of heaven.

        Whoever said plaintiff’s attorneys were altruistic? They get paid to do a job, same as doctors. Why should they lose money on such a case? Particularly $100,000 or more, which is what insurers claim it costs to take a case to trial. It’s no cheaper for the other side.

        You need to read the article more closely. The plaintiff’s attorneys don’t BELIEVE that, it’s the economic reality. And if you’re a plaintiff with an injury that is devastating enough that the noneconomic cap might apply, why would you pursue the case if you don’t have significant noneconomics? It’s a waste of your time since all your economic loss is probably medical bills, which is going right back to your provider!

        As for cites, can you point me to one plaintiff’s attorney saying a physician should provide limitless care to everyone regardless of cost? I’m doubting it, if it’s similar to your belief in the necessity of defensive medicine, which is based solely on thin anecdotal evidence.

        You’re the one who is applauding laws making it harder for the weakest members of our society to get access to a courtroom to make their case and if they can, arbitrarily limiting their recovery regardless of the negligence or their injuries so your insurer can save money and MAYBE pass it on to you. Where’s the glass house?

  3. Or are you disagreeing with me that doctors sold tort “reform” during the last “crisis” on the premise that there were physicians “disappearing” from states without it, and rural areas couldn’t get specialists without “reform”? Again, do I really need to cite that? Don’t you read your own lobbyists and your own insurers press releases and literature?

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