VULNERABLE children will fall through preventive health care gaps when the Healthy Kids Check is discontinued at the end of this month, two GPs have warned.
In a “Perspectives” article published in the MJA, Dr Karyn Alexander and Dr Danielle Mazza, of the department of general practice at Monash University, described the federal government’s axing of the one-off preventive health and developmental check for 4-year-olds as “a retrograde step for Australia’s future”. (1)
“By scrapping the HKC [Healthy Kids Check], not only are we reducing the chances of identifying problems earlier, but we are effectively reducing the capacity of general practice to promote the health and development of young children”, they wrote.
The federal government announced in its 2015 Budget that the HKC would end on 1 November, citing, among other things, a MJA review article from Dr Alexander and Dr Mazza claiming the check’s mandatory assessments did “not have a strong evidence base”. (2)
However, in this week’s MJA, Dr Alexander and Dr Mazza argue that the checks have nevertheless helped overcome barriers to preventive health care in general practice.
“Without protected opportunities to engage parents regarding child preventive health and without the signal that the HKC gives to parents that GPs are interested in such issues, children will continue to miss out on preventive health activities routinely delivered to other sectors of the population.”
Dr Evan Ackermann, a spokesman for the Royal Australian College of General Practitioners, said the axing of the HKC was one of a handful of recent government measures that could have a negative impact on children’s health, such as the Medicare rebate freeze in general practice, and the move to allow pharmacies to do vaccinations.
“Children’s health may well bear the brunt of poor health decision making”, he told MJA InSight, saying the decision to scrap the HKC meant additional funding that supported multidisciplinary care for childhood surveillance “is now gone”.
Melbourne paediatrician Professor Frank Oberklaid led a multidisciplinary expert working group in 2012 to advise the federal government on an expanded HKC designed to be administered at 3 years of age. He told MJA InSight that claims made at the time that the expanded version was a mental health check and would label children with mental illnesses were misinformed. (3)
Professor Oberklaid said it was disappointing that his group’s evidence-based evaluation report appeared to have been “lost in the depths of the federal Department of Health”.
“All the research is screaming out at us about the importance of investing in prevention”, he told MJA InSight. “Conditions as diverse as diabetes, obesity, mental health problems and criminality all start in the early years, and if we invest in early identification and early intervention before children start school some of these problems can be prevented.
“That was the goal of the check, and it is disappointing that this concept now seems lost.”
However, Dr Jon Jureidini, a child psychiatrist at the Women’s and Children’s Hospital, Adelaide, said he was “relieved” that the proposal for a 3-year-old check had disappeared.
“While diagnosing mental health problems in children might not have been the intention of the check, I fear that is how it would be used”, he told MJA InSight.
Dr Jureidini said that having a dedicated Medicare item number wasn’t the only way to drive child preventive health.
“Education and support for GPs and other staff in primary care is really important”, he said.
Dr Rae Thomas, a child developmental psychologist at Queensland’s Bond University, said it was unfair to suggest GPs would stop taking a preventive approach to child health once the item number disappeared.
Research she conducted with Dr Ackermann and others showed a considerable proportion of medical problems in children were detected by GPs outside of the HKC. (4)
However, Dr Thomas said the argument that early intervention was always necessary “is erroneous because it assumes there are interventions that work better at earlier stages than later stages, which sometimes isn’t the case”.
“We should carefully consider whether it is ethical to tell parents their child has a particular medical problem based on a test which may not be reliable, and when effective interventions aren’t available or aren’t accessible.”
The Department of Health did not respond to MJA InSight’s questions about the status of the report on the 3-year-old health check.
(Photo: ZouZou / shutterstock)
An interview with MJA coatuhor Dr Karyn Alexander is available as an MJA podcast and also as a video.