I’m at home today as my little guy was sent home from daycare before he was there long enough to wash his hands before breakfast. He is just not himself. He walked down the two steps from our garage to the ground instead of taking a HUMONGOUS JUMP from the last step over the puddle which is a tenth of an inch deep and eight inches wide. He always leaps when he is feeling good. He also has a fever of 101.3 F.
The daycare will require that we’ll bring in a doctor’s note before my son can go back. No big deal, I’m calling the pediatrician after I finish my coffee. I know the Nurse Practitioner will diagnose him with a daycare crud viral infection. She’ll recommend lollipops, lots of liquids, ibuprofen for pain and fever control, and lots of sleep.
From a system point of view, the pediatrician visit is most likely a wasteful visit. I know that, the day care knows that, the scheduler knows that, and the NP knows that (that is why she is getting the day care crud cases as she is the cheapest person who can see and prescribe common antibiotics, asthma medication and tests). However, from a cost perspective, this is probably waste, that at this time, is not high on anyone’s priority list to reduce. No one would complain if every kid saw the pediatrician one less time over the course of a long winter solely because they got a little bug and need a note to return to normal activity.
On a cost savings basis, one PCP visit per kid per year is peanuts. It might be $100 per kid per year. That is not nothing, but compared to emergency room overuse, or over-prescription of brand maintenance drugs instead of generics, or the refusal of Congress to allow Medicare to truly throw its weight around as the biggest buyer of medical services in the world, or heroic and counterproductive last stands, reducing pediatric utilization by a visit per kid per year is a drop in the bucket.