An Equity Imbalance in Australian Children&Apos;S Access to Healthcare: Quantifying the Health Service Use and Costs for Children Born into Vulnerable Families

Abstract

Background: Being born into a vulnerable family (at risk of becoming or remaining poor) is a significant risk factor for childhood poverty, impairing a child’s start to life and perpetuating intergenerational cycles of poverty. This study sought to understand equity in Australian children’s access to health services by quantifying health service utilisation, costs and funding distribution amongst children born into vulnerable compared to non-vulnerable families. Methods: This study used a large linked administrative dataset for all women giving birth in Queensland, Australia between July 2012 and July 2018. Health service use included inpatient, Emergency Department (ED), General Practice (GP), specialist, pathology and diagnostic imaging services. Costs included those paid by public hospital funders, private health insurers, Medicare and out-of-pocket costs. Findings: Vulnerable children comprised 34.1% of the study cohort. Compared to non-vulnerable children, they accessed significantly higher average numbers of inpatient (0·83±2·06 vs 0·80±2·01) and ED (2·52±3·63 vs 1·97±2·77) services during the first five years of life, and significantly lower average numbers of GP, specialist, pathology, and diagnostic imaging services. Vulnerable children incurred significantly greater costs to public hospital funders compared to non-vulnerable children over the first five years of life ($8,274 vs $7,063), and significantly lower private health insurer, Medicare and out-of-pocket costs. Interpretation: There are clear inequities in vulnerable children’s access to health services in Australia. Greater examination of the uptake and cost-effectiveness of maternal and child services is needed, as these services support children’s development in the critical first 1,000 days of life. Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: This study received ethical approval from the Townsville Hospital and Health Services Human Research Ethics Committee (HREC) (HREC/16/QTHS/223), and the Australian Institute of Health and Welfare HREC (EO2017-1-338). Public Health Act approval was also obtained (RD007377).