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September NaN, 1998

Physician Recommendations vs Insurance Coverage for Growth Hormone

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;280(12):1052-1054. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-12-jbk0923

To the Editor.—If Dr Finkelstein and colleagues1 wanted to show that insurance carriers are unwilling to pay for necessary or even desirable treatments, they could not have chosen a worse example than GH therapy. Although there is a consensus in the medical community that children with documented GH deficiency should be treated with GH replacement, the authors' data demonstrate that for "idiopathic short stature" there is as much difference of opinion among physicians as between physicians and insurance carriers. In the worst of the 4 case scenarios presented, 95% of primary care physicians but only 58% of pediatric endocrinologists would recommend treatment. It follows that 42% of pediatric endocrinologists would not treat even in this worst case. In the other 3 cases the majority of pediatric endocrinologists would agree not to treat. Since the cost of treatment is high, the benefits are purely cosmetic, and the long-term risks of treating children who are not hormone deficient are unknown, this reluctance to treat is understandable.

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