Are Poor Children Overmedicated?
A forthcoming volume of Health Affairs will include the surprising finding that children on Medicaid are four times more likely to be prescribed anti-psychotic medications than their privately insured counterparts, a disparity that exceeds even the higher rates of mental health issues (2 to 1) faced by poor children. Even more troubling, these kids are receiving powerful meds for lesser disorders, such as ADHD. Given the serious, long-term side effects of anti-psychotics, we need to ask ourselves whether we are stabilizing these childrens' lives in an accessible, cost-effective manner or subjecting them to needless harm.
Determining whether the relative over-prescription of poor children is a positive or negative thing depends on a couple of key factors. To start, you have to ask whether middle-class kids are receiving sufficient mental health treatment, including medication? That is, should they be our measuring stick?
Second, medications for Medicaid-insured kids often supplant less-accessible, more expensive treatments, such as therapy and counseling. The conventional wisdom surrounding poverty, health care, and access is that the poorer one is, the less access she has to medical care. Although we've made strides nationally to insure and treat low-income kids through programs like SCHIP, access to medical care remains highly dependent on geographically available and affordable services and medications, with schools and guardians playing a critical role in ensuring children are receiving care. So, while overmedicated kids might be alarming, it's only a symptom of the real problem: the Medicaid reimbursement system, which leaves doctors prescribing medicine as a consolation prize for kids who require long-term therapy.
Taking these health care realities into consideration, are families benefiting from some treatment, even off-label use of anti-psychotics for diagnoses such as ADHD? Are the drugs bringing some level of stability to households that outweighs the costs of medicating young children? For the doctors and parents interviewed in the original article, there's no consensus on whether this is a good or bad practice. It's just reality.
Personally, I've been amazed at how much therapy and treatment my low-income family has been able to access on MassHealth; I realize they have a skill I don't possess at navigating and advocating for themselves and their children in a complex, bureaucratic and unfair system. (It also helps that they're white.) But what comes through in the findings on poor children and anti-psychotics use, and poverty and health care access more generally, is that caregivers and children themselves need to learn this critical skill.
I'm less concerned that kids are receiving so many meds versus whether this is what they and their parents have asked for from our health care system, after taking into consideration their circumstances and options. As our nation battles over increasing and equalizing health care access for all Americans, we need to make sure that this access is informed and autonomous for everyone.
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