The Prime Minister Julia Gillard has announced plans to penalise parents receiving welfare payments who do not ensure their children have a health check at age four.
The aim, she says, is to make sure that when children get to school, they have been checked to see if there is any health complaint that might affect their ability to learn. A re-elected Gillard Government “will tie the provision of the annual supplement in Family Tax Benefit for welfare families to having the appropriate health check for four year old children”.
The AMA has already raised concerns about the lack of evidence to support this approach, and below are two articles by Croakey contributors who have some serious reservations.
Potential for negative consequences
Professor Mark Harris and Dr Elizabeth Denney-Wilson, of the UNSW Research Centre for Primary Health Care and Equity, write:
Yesterday was a big day in the campaign with the Rooty Hill forums, the National Press Club health debate, and the Prime Minister’s relocation payment for the unemployed. In amongst these events was an important announcement – that families on Family Tax Benefit Part A would be penalised $720 for failing to have their children attend their GP for the recently introduced 4 year old health check.
While encouraging children to attend for a health check may help detect health problems early, this penalty was surprising given the lack of research showing that this health check can improve children’s health especially for low income families (see this recent editorial by Dr Karyn Alexander in the Medical Journal of Australia).
The healthy kids check is performed by a child’s “usual” GP (often completed by the practice nurse). It involves checking height and weight, eyesight, hearing, oral health and toilet habits and may also involve a review of healthy eating, activity, speech and language development, fine motor skills, behaviour and mood. Not all practices have the capacity to conduct the health check – they either don’t have time due to competing demands or do not feel confident in all aspects of the assessment.
We recently surveyed practice nurses about their experience of conducting the healthy kids check. They reported that many parents are suspicious that the check implies a criticism of their parenting and so they are reluctant to attend. Other parents find it difficult to fit in between work and caring for the rest of the family.
The introduction of this penalty may help get parents along for the check but may further reinforce their suspicions.
A good idea – but does it work?
Dr Lesley Russell writes:
As part of Labor’s election policy, Prime Minister Julia Gillard has announced new rules requiring parents of four-year-olds to take the children for health checks before they can receive the $726.35 family tax benefit part A.
But there’s a problem – Healthy Kids’ Checks are not working. Only a fraction of four-year olds get this health check, and there is no evidence that those children who do get one benefit from it.
Medicare data show that in the 2 years since introduction in July 2008, only 81,463 Healthy Kids’ Checks have been done, at a cost of $3.79 million. That’s well below what was anticipated for a nation with some 260,000 four-year olds, and a program that was budgeted to cost $25.6 million over 4 years.
As the graph shows, the majority of the Healthy Kids’ Checks are done by Practice Nurses, and there is only a slight indication, more obvious in 2009 than 2010, that the rate at which these checks are done is linked to the start of the school year.
In contrast, it is possible to see a boost in the number of immunisations delivered by Practice Nurses around February / March each year, which presumably reflects school requirements.
The key issue is what happens as a consequence of these checks – are they sufficient to detect problems and what do doctors (and parents) do when they find problems?
The only mandatory requirements are that children’s eyesight, hearing, oral health, toilet habits and allergies are checked, although doctors or nurses may ask about eating habits, physical activity, speech and language development, motor skills, and behavioural problems. However, there is nothing to require that children get the follow-up medical care, eyeglasses, hearing assistance or speech therapy they might need.
It’s not a good precedent to be citing Medicaid (the US federal / state program which provides health care for the poor) here, but the Medicaid Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program is an exemplar of what should be done.
EPSDT is a mandatory set of services and benefits for all individuals under age 21 who are enrolled in Medicaid, designed to address physical, mental, and developmental health needs. Screening services to detect physical and mental conditions must be covered at periodic intervals, as well as diagnostic and treatment coverage.
The treatment component of EPSDT is broadly defined and must include the necessary health care, diagnostic services, treatment and other measures that are needed to correct or ameliorate physical and mental illnesses and conditions discovered by the screening services. In order to ensure access to needed services, assistance in scheduling appointments and transportation assistance to keep appointments must also be provided.
A recent paper published in the Medical Journal of Australia found that most of the components of the Healthy Kids’ Check are not supported by evidence-based guidelines.
In the age of (supposed) evidence-based policy making, this new proposal to mandate Healthy Kids’ Checks for a segment of the population seems to be a classic case of throwing good money after bad.
• Dr Lesley Russell is the Menzies Foundation Fellow at the Menzies Center for Health Policy, University of Sydney/ Australian National University and a Research Associate at the US Studies Centre, University of Sydney. She is currently a Visiting Fellow at the Center for American Progress in Washington DC.