title: Use of Low-Value Pediatric Services Among the Commercially Insured.
abstract: Claims-based measures of "low-value" pediatric services could facilitate the implementation of interventions to reduce the provision of potentially harmful services to children. However, few such measures have been developed.
  
  
  
  We developed claims-based measures of 20 services that typically do not improve child health according to evidence-based guidelines (eg, cough and cold medicines). Using these measures and claims from 4.4 million commercially insured US children in the 2014 Truven MarketScan Commercial Claims and Encounters database, we calculated the proportion of children who received at least 1 low-value pediatric service during the year, as well as total and out-of-pocket spending on these services. We report estimates based on "narrow" measures designed to only capture instances of service use that were low-value. To assess the sensitivity of results to measure specification, we also reported estimates based on "broad measures" designed to capture most instances of service use that were low-value.
  
  
  
  According to the narrow measures, 9.6% of children in our sample received at least 1 of the 20 low-value services during the year, resulting in $27.0 million in spending, of which $9.2 million was paid out-of-pocket (33.9%). According to the broad measures, 14.0% of children in our sample received at least 1 of the 20 low-value services during the year.
  
  
  
  According to a novel set of claims-based measures, at least 1 in 10 children in our sample received low-value pediatric services during 2014. Estimates of low-value pediatric service use may vary substantially with measure specification.
authors.affiliation: Sections of Academic Pediatrics, and kchua@peds.bsd.uchicago.edu.|Department of Public Health Sciences, University of Chicago, Chicago, Illinois; and.
authors.forename: Kao-Ping
authors.initials: KP
authors.lastname: Chua
authors.affiliation: Harvard Medical School, Boston, Massachusetts.
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Schwartz
authors.affiliation: Sections of Academic Pediatrics, and.|Section of General Internal Medicine, Department of Medicine, and.
authors.forename: Anna
authors.initials: A
authors.lastname: Volerman
authors.affiliation: Department of Public Health Sciences, University of Chicago, Chicago, Illinois; and.|Pediatric Hematology/Oncology, Department of Pediatrics.
authors.forename: Rena M
authors.initials: RM
authors.lastname: Conti
authors.affiliation: Section of General Internal Medicine, Department of Medicine, and.
authors.forename: Elbert S
authors.initials: ES
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000191:economics* / Q000706:statistics & numerical data; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007348:Insurance, Health / Q000191:economics*; D008297:Male; D010372:Pediatrics / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States