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 shows that in the two 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 four 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 murses about 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 that 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 the age of 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 Centre 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.