Rethinking well-child care in the United States: an international comparison.

BACKGROUND The increasing scope of health supervision recommendations challenges well-child care delivery in the United States. Comparison of the United States with other countries' delivery systems may highlight different assumptions as well as structural approaches for consideration. OBJECTIVE Our goal was to describe the process of well-child care delivery in industrialized nations and compare it to the US model of child health care. METHODS Literature reviews and international experts were used to identify 10 countries with unique features of well-child care delivery for comparison to the United States. Key-informant interviews using a structured protocol were held with child health experts in 10 countries to delineate the structural and practice features of their systems. Site visits produced additional key informant data from 5 countries (The Netherlands, England, Australia, Sweden, and France). RESULTS A primary care framework was adapted to analyze structural and practice features of well-child care in the 10 countries. Although well-child care content is similar, there are marked differences in the definitions of well-child care and the scope of practice of primary care professionals and pediatricians specifically who provide this care across the 10 countries. In contrast to the United States, none of the countries place all well-child care components under the responsibility of a single primary care provider. Well-child care services and care for acute, chronic, and behavioral/developmental problems are often provided by different clinicians and within different service systems. CONCLUSIONS Despite some similarities, well-child care models from other countries differ from the United States in key structural features on the basis of broad financing differences as well as specific visions for effective well-child care services. Features of these models can inform child health policy makers and providers in rethinking how desired improvements in US well-child care delivery might be sought.