Jane McCredie: Wielding a blunt stick

IT’S a generally accepted principle in preventive health that carrots work better than sticks — giving people an incentive to adopt a desirable behaviour is likely to be more effective than punishing them for an undesirable one.

So why has the federal government decided to switch from rewards to sanctions when it comes to childhood immunisation?

The short answer is $200 million, the amount it expects to save over 4 years as a result of its decision to dump the maternity immunisation allowance, currently paid in two instalments of $129 to parents who immunise their children.

From 1 July next year, it will instead take a new punitive approach that will see parents who don’t comply with the immunisation schedule lose the family tax benefit part A — a cost of just over $2100 per child in lost benefits.

Now, I’m all in favour of measures that boost immunisation rates but I wonder if these changes will actually do that, despite the government’s claimed motivation of creating a “stronger financial incentive” for parents to immunise.

A discussion paper on the use of financial incentives in health, commissioned by the National Health and Hospitals Reform Commission, found that rewarding positive health behaviours with financial incentives appeared more likely to be effective than penalising negative ones.

“Financial penalties should be used with caution, as they may penalise the least well off, who may be most in need of preventive care”, wrote the authors from the Melbourne Institute of Applied Economic and Social Research.

It’s hard to know just how effective the immunisation allowance has been, as it’s pretty well impossible to disentangle its effects from those of the incentives paid to GPs for ensuring children are immunised (the GP incentives will continue under the new system).

So, maybe it’s no great loss, especially given that the payment never actually required parents to immunise their children at all.

Bizarrely, parents still received the money if they registered a formal conscientious objection to immunisation based on a “personal, philosophical, religious or medical” belief.

That exemption will remain in place under the new arrangements. In fact, there’s more justification for it under a punitive system than there was under a rewards-based one.

Of course, the most vehement opponents of vaccination would hardly have changed their minds for financial reasons, even without that exemption. So who is likely to be affected by the new approach?

Chances are it will be children living on the edge, those in chaotic or dysfunctional families, those who don’t receive regular medical care and whose parents are certainly not going to visit a GP to make a conscientious objection.

In other words, “the least well off, who may be in most need of preventive care”.

Jane McCredie is a Sydney-based science and medicine writer.

Posted 5 December 2011

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