Plan Features to Evaluate (continued) 2. Pediatric Provider Network Capacity Almost all health plans cover physician and hospital services. Plans differ, however, with regard to the mix of child health professionals used. Many use a combination of pediatricians, family physicians, and nurse practitioners to deliver primary care services to children. Plans also vary with regard to the availability of adult versus pediatric subspecialists and the availability of general hospitals versus hospitals specializing in the care of children. Understanding how each plan organizes its comprehensive network of pediatric services is critical to the care of all children, particularly those with chronic conditions. The following list of questions can help guide purchasers in assessing health care plans' pediatric network capacity.

A. Are pediatricians included as primary care clinicians?	Yes____No____
B. Does the plan recruit physicians and other health professionals with expertise in the care of children with chronic conditions?	Yes____No____
C. Does the plan make exceptions to allow specialists to serve as primary care clinicians for certain children with complex conditions?	Yes____No____
D. Does the plan allow for shared management of children with chronic conditions between primary care physicians and subspecialists?	Yes____No____
E. If the primary care or specialty care providers of a child with a chronic condition is not in the plan's network, are exceptions made to reimburse the physician to assure continuity of care?	Yes____No____
F. Does the plan rely on pediatric subspecialists - not adult subspecialists - to care for children with chronic conditions?	Yes____No____
G. Does the plan have an up-to-date inventory which lists and describes pediatric professionals within the plan who are expert in the care of children with chronic conditions?	Yes____No____
H. Does the plan include or contract with the following primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists in the following areas? (If not, what alternative arrangements are used to assure access to these pediatric subspecialists?)	Yes____No____
Adolescent medicine	Yes____No____
Allergy/immunology	Yes____No____
Anesthesiology	Yes____No____
Cardiology	Yes____No____
Child and adolescent psychiatry	Yes____No____
Critical care	Yes____No____
Dermatology	Yes____No____
Developmental/Behavioral medicine	Yes____No____
Emergency medicine	Yes____No____
Endocrinology	Yes____No____
Gastroenterology	Yes____No____
Genetics	Yes____No____
Hematology/Oncology	Yes____No____
Infectious disease	Yes____No____
Neonatology/Perinatology	Yes____No____
Nephrology	Yes____No____
Neurology	Yes____No____
Neurosurgery	Yes____No____
Ophthalmology	Yes____No____
Oral surgery	Yes____No____
Orthopedics	Yes____No____
Otolaryngology	Yes____No____
Pediatric surgery	Yes____No____
Plastic surgery	Yes____No____
Pulmonology	Yes____No____
Radiology	Yes____No____
Rheumatology	Yes____No____
Urology	Yes____No____

Pediatric Provider Network Capacity (continued...)

Index | Introduction Pediatric Services Covered and Cost-Sharing Requirements Pediatric Provider Network Capacity Pediatric Provider Network Capacity (continued...) Evaluating Quality Management