Primary health‐care costs associated with special health care needs up to age 7 years: A ustralian population‐based study

Aim We studied infants and children with and without special health care needs ( SHCN ) during the first 8 years of life to compare the (i) types and costs to the government's M edicare system of non‐hospital health‐care services and prescription medication in each year and (ii) cumulative costs according to persistence of SHCN . Methods Data from the first two biennial waves of the nationally representative L ongitudinal S tudy of A ustralian C hildren, comprising two independent cohorts recruited in 2004, at ages 0–1 ( n = 5107) and 4–5 ( n = 4983) years. Exposure condition: parent‐reported Children with Special Health Care Needs Screener at both waves, spanning ages 0–7 years. Outcome measure: F ederal G overnment M edicare expenditure, via data linkage to the Medicare database, on non‐hospital health‐care attendances and prescriptions from birth to 8 years. Results At both waves and in both cohorts, >92% of children had complete SHCN and M edicare data. The proportion of children with SHCN increased from 6.1% at age 0–1 years to 15.0% at age 6–7 years. Their additional Medicare costs ranged from $491 per child at 6–7 years to $1202 at 0–1 year. This equates to an additional $161.8 million annual cost or 0.8% of federal funding for non‐hospital‐based health care. In both cohorts, costs were highest for children with persistent SHCN s. Conclusions SHCN s incur substantial non‐hospital costs to M edicare, and no doubt other sources of care, from early childhood. This suggests that economic evaluations of early prevention and intervention services for SHCN s should consider impacts on not only the child and family but also the health‐care system.