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Arch Pediatr Adolesc Med. 2003;157:1032-1033.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

I read the article, "Referral of Children to Specialists in the United States and the United Kingdom [UK]"¹ with interest. I applaud the authors' long-standing and continued dedication to understanding children's access to and use of specialty services in the United States, a poorly understood issue.

I appreciate the authors' restraint in using their findings to determine whether subspecialty use rates in the United States are too high or those in the UK are too low. I do wonder, however, to what extent the higher treatment morbidity index in the UK may result from insufficient access to subspecialty care. Without more detail as to how this index is measured, it is difficult to know if there is a potential for reverse causation.

One concern I have about the findings, which is touched on briefly by the authors, is the selected population studied in the United States. As the authors note, . . . [Full Text of this Article]

Michelle L. Mayer
Department of Health Policy and Administration
School of Public Health
University of North Carolina–Chapel Hill
Chapel Hill, NC 27599

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