consistently providing quality emergency care to children, and that continued efforts are needed to address its deficiencies.

The chapter concludes with a look at the financing of pediatric emergency care services. This review highlights a number of issues surrounding reimbursement for pediatric services and/or reimbursement at children’s hospitals that have become a growing problem for some providers.

DEVELOPMENT OF EMERGENCY CARE FOR CHILDREN

1940s–1960s: The Beginning of the Modern Emergency Care System

The modern emergency room developed at a time when the specialization of medical practice swept the nation after World War II. As the number of house calls from general physicians declined, patients increasingly turned to the local hospital for treatment. This trend was reinforced by the development of private insurance plans, which geared payments toward hospitals and away from home visits (Rosen, 1995). The development of the emergency room also reflects the passage of the Hill-Burton Act of 1946, which gave states federal grants to build hospitals provided that the states met a variety of conditions, including a community service obligation. Among other things, the community service obligation required hospitals that received the federal funding to maintain an emergency room. This requirement applies to the vast majority of nonprofit U.S. hospitals in operation today (Rosenblatt et al., 2001).

Emergency care as a field advanced as the result of several forces that drew attention to emergency care in the 1950s and 1960s. One was new knowledge about the value of prompt prehospital treatment and transport derived from military experience in Korea. During that conflict, technical innovations such as the creation of battalion aid stations and rapid transport by helicopter to mobile field hospitals were introduced and resulted in dramatically improved survival rates for battle-wounded soldiers. Experience in Vietnam led to advances in trauma care. Surgeons returning to the United States from Korea and Vietnam recognized that the systems developed by the Army for triage, transport, and field surgery could surpass anything available to civilians at home (Rosen, 1995), and they believed that similar innovations could and should be applied to civilian care. Around the same time, advances in cardiac care, such as the creation of “mobile coronary care units,” improved the survival rate of patients prior to reaching the hospital (Pantridge and Geddes, 1967).

Another major turning point was the publication of the landmark National Academy of Sciences (NAS)/National Research Council (NRC) report Accidental Death and Disability: The Neglected Disease of Modern Society



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