A just published study looking at the cost of child health inequities in New Zealand – led by Northland public health physician Dr Clair Mills with University of Auckland Business School economist Dr Rhema Vaithianathan and Faculty of Medical and Health Sciences academic Dr Papaarangi Reid – shows that Māori children face an unequal burden of avoidable illnesses and deaths compared with their non-Māori peers.
It says Māori children are nearly 30% more likely to be admitted to hospital and twice as likely to die from ‘avoidable conditions’ – illnesses or deaths that could be prevented by good primary care or other measures such as immunisation or injury prevention approaches. These health problems include Sudden Unexplained Death in Infants (commonly known as ‘cot death), respiratory illnesses and injuries.
And if Māori rates of avoidable death, illness and healthcare utilisation equalled non-Māori, the researchers say each year there would be nearly 70 fewer deaths of Māori children and 3075 fewer admissions to hospital annually.
But researchers say that perversely, if only annual costs are considered, the health sector actually ‘saves’ nearly $25 million through maintaining health services that do not equitably serve Māori children’s health needs.
“In other words,” Dr Mills says, “annual health sector spending on hospital admissions for severely ill children is less than it would cost to reduce inequities in access to GPs, laboratories, pharmacies, ACC and outpatient services.
“However, maintaining the status quo – that is, not addressing the problems of greater ill health and more deaths of Māori children – results in large societal costs for all of us, as well as longterm health and other costs to whanau, like missed education, unemployment, grief and suffering.”
The study, which aims to estimate how much this issue costs New Zealand society, showed that if Māori children accessed healthcare services at the rate of non-Māori children, each year there would be:
• 23,000 more outpatient consultations;
• 26,400 more ACC claims;
• More than 40,000 more GP consultations;
• Nearly 200,000 more pharmaceutical claims, and;
• 102,000 more lab claims for Māori children.
“We know that inequities are not inevitable or unchangeable, and that these avoidable hospitalisations and deaths can be reduced,” Dr Mills says. “This study suggests greater investment in interventions which have been shown to improve equity in child health outcomes, including housing improvements and primary care access, makes economic sense as well as being ‘the right thing to do’.
“Inequity in this area has a lifelong effect, and contributes significantly to adult disparities. Although health inequities are recognised as unfair and amenable to policy intervention by some, this study suggests there are also strong economic arguments for addressing them.”
The study, which has been published in an international public health journal, shows that more than half “excess” avoidable deaths in Māori children occur in the age group between 28 days and one year. Sudden infant death, respiratory, skin, ENT, circulatory diseases and injuries feature prominently as causes of the excess burden of illness and deaths borne by Māori children.
The research shows:
• 15,376 ‘excess’ avoidable hospital admissions for Māori children during the period 2003 to 2007;
• 36% of hospitalisations classified as ‘potentially avoidable’;
• Tamariki Māori accessed GP consultations at a lower rate than non-Māori;
• Pharmaceutical claims for non-Māori children were 15 % higher, with non-Māori laboratory claims 55% higher than Māori;
• ACC claims for Māori children 32% lower than non-Māori, and median cost lower;
• Specialist outpatient visits by Māori children 86% lower than those of non-Māori children.
“The trouble is that decisions such as who benefits, future and current values, and applying monetary values to life and illness/disability, require ethical judgements…and children are rarely the focus,” Dr Vaithianathan says.
Whilst working out the economic impact of the problem used a simple costing approach, it did not take into account the lifetime costs, intangibles and the grief and suffering of whanau, she says.
“Any economic impact analysis undercounts the true cost of this inequity. There are also methodological issues in economic analyses that need to be challenged and addressed when costing child health and inequities, as many of the assumptions made in classical economics do not apply well to children.”
The University of Auckland