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Cost of health care: Does your child really need that test?

Imagine going to a restaurant where the menu is in a foreign language. You hand your credit card to the server and tell her to order whatever she wants for you. Wanting you to have the best possible experience, she’ll come up with the most wonderful meal, which will end up giving you more food than you want or need. And, of course, the bill will be pretty hefty.

Going to the doctor can feel a little like that. One way to try to control the cost of medical care for your child is to ask a few questions when the providers suggest tests or treatments. For now, we’ll focus on testing.


Screening tests

A screening test is designed to find a disease in someone who might not be showing any symptoms. For instance, all newborns have screening for a variety of metabolic diseases. If your doctor wants to do screening, ask if it is according to any guidelines. For example, the American Academy of Pediatrics used to recommend a blood test to screen all children for lead poisoning, but the latest guidelines suggest asking questions to assess the child’s risk to decide who needs a blood test.

Diagnostic tests

If your provider suspects your child may have a condition, they may do one or more diagnostic tests. One very important thing to know is that for most diseases, there is not a test that says definitively whether the disease is there or not. Rather, the results usually indicate whether the disease is more or less likely. Some tests can give a very good indication, while others add only a little information.

Here are some things you can ask the provider:

Question: What disease are you testing for, and is this the best test for that condition? If there are a few options, what are the differences in terms of accuracy, cost and side effects?

For example, if your child has abdominal pain and the provider is concerned about appendicitis, there are two tests that can identify it: ultrasound or CT scan. Ultrasound is somewhat less accurate, but is less expensive and does not expose the child to radiation. Most guidelines recommend starting with ultrasound. (Plain X-rays are often done, but are not useful in diagnosing appendicitis. If your doctor orders one, ask what else they are thinking about.)

Question: If more than one test is being done, are they all necessary, or are some of them redundant? Do they all need to be done at once, or can you wait to see what the results of the first test are before doing more?

Let’s say your child has a fever and cough. Your doctor might order a flu test, and also a chest X-ray to check for pneumonia. Since flu is far more common than pneumonia, you should ask about waiting to do the X-ray until the flu test comes back, possibly avoiding an unnecessary X-ray.

Question: What results are you looking for, and what will be the next step based on the results?

Doctors have traditionally performed a blood count in children with fever. Although a higher white blood cell count makes it slightly more likely that the cause of the fever is a bacterial infection, by itself it doesn’t change the likelihood very much. Your provider should be able to explain what she will do if the result is a high white blood cell count versus a normal one. If they aren’t going to do anything different, then it’s reasonable to question whether the test is necessary.

Get an explanation

Remember, your provider is an expert on the diagnostic tests, but they should be able to explain what they are doing and why. If you want to keep your bill reasonable, ask them to translate the menu and explain the options before ordering a big meal for you!