Evidence-based health care coverage for children: Proceed with caution

Making health care coverage depend on the existence of valid, applicable re search data and positive cost-effectiveness analyses, as managed care contr acts are beginning to do, is particularly problematic for children. Because of research challenges specific to children, there are relatively few pedi atric data and analyses required under such evidence-based coverage standar ds. It is too soon to expect major increases from federal efforts to stimul ate pediatric health care research. But absence of requisite evidence would entitle a managed care organization or other decision maker to deny covera ge on the basis of unproven, negative assumptions about an intervention. In general, population-based evidence is an incomplete basis for decisions on coverage for individual patients. Cost-effectiveness analyses are not stan dardized and may be biased. Purchasers of managed care and policy makers sh ould understand the limits of evidence-based coverage standards. Other uses of evidence may contribute more to systemic improvements of health care.