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Serious concerns raised about Gillard’s child health check plans

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.
Snapshot 2010-08-12 11-56-00
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.

Comments 4

  1. Fiona says:

    4 years old getting a bit late if they haven’t seen anyone since their 18 months check… I’m just thinking from a speech and language point of view, my service gets many referrals at 18 months for late talkiers and then again at the 3ish year old MACH nurse screen for those who haven’t cauught up in that time, 3 still allows for a couple of years of early interventon thorugh preschools and therapy services. a few months before they may well be starting promary school if they live in NSW does not.

    Are 3 year old checks still occuring in all states by child heath nurses? Or screening at their immunicsation times? If a kid hasn’t been seen until 4 by a medical professional then there’s going to be panic stations all around if they present with any significant delays, and that’s before they hit school.

    And there is no requirement that parents access therapy services. Good luck making a child protection report if they failto attend therapy appointments… :

  2. Narrandera GP Management says:

    Our practice is too busy trying to see ordinary patients. Our practice covers all medical services in the town 24/7 – so if we send patients to the hospital, we have to send the doctor up there as well. We have a 3-4 week wait list for regular appointments. If these patients are very lucky they will not be rescheduled due to an emergency or unforeseen change to the roster.

    We trained one of our three nurses in 4 year old health checks and she left us. We can’t afford the time to send another nurse to be trained. And if the nurse did commence the check, there would be no doctors available to sign off on the check.

    Our nurses are also too busy assisting the doctors to see patients for these health checks. Already we have to NOT DO other health checks because we do not have the time to spend on them. We would love to comply with all of these wonderful initiatives. Our doctors are just too busy.

    There are many overseas trained doctors who would love to come and work in the country. We would love to have their skills, and if they don’t have enough, they will get on the job training here – we train registrars. But it is made so difficult it is near impossible for us to get the doctors we need. The government shows no interest in using them to take up the slack until the influx of increased Aussie students take up all the available positions (after our overloaded doctors have trained them – on top of their work).

  3. Drdebbie says:

    There seems to be a misconception amongst politicians that doing a health check automatically translates to better health. Where I work, waiting times for public ENT clinics are years, there are no public eye clinics, public paediatric waiting times are months and there are very inadequate counselling services for children. I can see parents bringing their 4 year olds in demanding a health check so they can access their family tax benefit, not admitting to any health concerns re their child for fear that will affect their eligibility and any problems found will not be able to be adequately addressed anyway because of a lack of appropriate, affordable and timely backup services.
    I am tired of governments and health bureaucrats coming up with ideas that may sound good and with the best of intentions( perhaps??) but with no chance of actually improving health outcomes in the community.

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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
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Closing the Credibility Gap 2013
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Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
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2014 conferences
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AIDA Conference 2014
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National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
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Population Health Congress 2015
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