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US healthcare reform and the evidence gap: the need for high-quality research in paediatric preventive care
  1. Caroline J Kistin
  1. Division of General Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Caroline J Kistin
    Division of General Pediatrics, Boston University School of Medicine/Boston Medical Center, 88 East Newton Street, Vose 3, Boston, MA 02118, USA; caroline.kistin{at}bmc.org

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In 2010, the US Congress passed landmark healthcare reform legislation known as the Personal Protection and Affordable Care Act.1 Although many aspects of the reform continue to provoke debate and face political challenges to implementation, one of the less-controversial provisions concerns the promotion of evidence-based preventive care. The explicit emphasis on expanded insurance coverage of proven clinical practice is intended to increase and standardise access to preventive services with the goal of improving individual and public health.2 At the same time, the evidence-based provisions in the bill reflect the existing evidence gap between paediatric and adult practice and reinforce the ongoing need for high-quality research in paediatric preventive care.

In the Act, new insurance plans are required to provide coverage for selected preventive clinical services with no copayment on the part of the patient. The qualifying services are defined as: (1) services recommended with either an A or a B rating by the US Preventive Services Task Force (USPSTF), (2) immunisations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and (3) additional preventive care and screenings recommended for children and adolescents, as well as women, by the Health Resources and Services Administration. There are important differences between the recommendations of the USPSTF and the Health Resources and Services Administration with regards to paediatric services that highlight the challenges in providing evidence-based care in paediatrics.

The recommendations of the USPSTF, which are …

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