Reducing the Inequalities in Maori Child Deaths Makes Economic Sense, Economists Say

06 August 2012

Avoidable deaths of Maori children in New Zealand are costing the country at least 67 lives and around $200 million per year in economic impact, but greater Government spending on primary care and other key interventions could help to resolve the problem, health researchers say.

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 Maori children face an unequal burden of avoidable illnesses and deaths compared with their non-Maori peers.

It says Maori 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 Maori rates of avoidable death, illness and healthcare utilisation equalled non-Maori, the researchers say each year there would be nearly 70 fewer deaths of Maori 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 Maori 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 Maori 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 Maori children accessed healthcare services at the rate of non-Maori 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 Maori 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 Maori 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 Maori children.

The research shows:

  • 15,376 ‘excess’ avoidable hospital admissions for Maori children during the period 2003 to 2007
  • 36% of hospitalisations classified as ‘potentially avoidable’; • Tamariki Maori accessed GP consultations at a lower rate than non-Maori;
  • Pharmaceutical claims for non-Maori children were 15 % higher, with non-Maori laboratory claims 55% higher than Maori;
  • ACC claims for Maori children 32% lower than non-Maori, and median cost lower;
  • Specialist outpatient visits by Maori children 86% lower than those of non-Maori 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.

Avoidable deaths of Maori children in New Zealand are costing the country at least 67 lives and around $200 million per year in economic impact, but greater Government spending on primary care and other key interventions could help to resolve the problem, health researchers say. 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 Maori children face an unequal burden of avoidable illnesses and deaths compared with their non-Maori peers. It says Maori 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 Maori rates of avoidable death, illness and healthcare utilisation equalled non-Maori, the researchers say each year there would be nearly 70 fewer deaths of Maori 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 Maori 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 Maori 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 Maori children accessed healthcare services at the rate of non-Maori 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 Maori 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 Maori 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 Maori children. The research shows: • 15,376 ‘excess’ avoidable hospital admissions for Maori children during the period 2003 to 2007; • 36% of hospitalisations classified as ‘potentially avoidable’; • Tamariki Maori accessed GP consultations at a lower rate than non-Maori; • Pharmaceutical claims for non-Maori children were 15 % higher, with non-Maori laboratory claims 55% higher than Maori; • ACC claims for Maori children 32% lower than non-Maori, and median cost lower; • Specialist outpatient visits by Maori children 86% lower than those of non-Maori 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.”

Paper available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404015/?tool=pubmed