The intersection of developmental vulnerability and socioeconomic disadvantage on access to health care for preschool aged children: evidence for the inverse-care law

Abstract

Aim. Children who are developmentally vulnerable have greater health needs. Socioeconomic disadvantage not only increases this risk of developmental vulnerability but can be associated with less access to health services. Our aim was to compare health services use in children aged 4-5 years in Australia with and without developmentally vulnerability and consider the intersection of socioeconomic disadvantage on this relationship. Method. Cross sectional data were collected from Wave 3 of the Longitudinal Study of Australian Children birth cohort when the children were aged 4-5 years. A composite variable for developmental vulnerability was designed by combining those children who were in the lowest 15% in the physical, socioemotional and/or learning outcome indices. Children were then subgrouped according to developmental vulnerability and disadvantage based on socioeconomic position (SEP) quintile (derived from parental education, occupation, household income). We defined SEP 1 the lowest quintile as ‘disadvantaged’ and SEP quintiles 2-5 as ‘not disadvantaged’. Multivariate regression was used to examine the intersection between health service use and developmental vulnerability and disadvantage using these composite variables. Results The total number of children with information on developmental vulnerability in Wave 3 was 3967 (90% of the sample). A total of 1292 (32.6%) children were classified as developmentally vulnerable. 30.6% of children who were developmentally vulnerable came from families who were disadvantaged. Overall children who were developmentally vulnerable were reported to use more specialist/hospital health services than those who were not developmentally vulnerable (10-25 % vs 5-16%). Children who were developmentally vulnerable and not disadvantaged were 1.4-2.0 times more likely to have reported using a GP, paediatrician, other specialist, and Emergency Department compared with children who were developmentally vulnerable and disadvantaged. Conclusion Preschool children who are developmentally vulnerable have a higher reported use of specialist and hospital services compared with those who are not developmentally vulnerable. There is evidence of an inverse care law; those who were not disadvantaged with and without developmental vulnerability are more likely to use health services compared with their counterparts who were disadvantaged.

Critical success factors for school‐based integrated health care models: Learnings from an Australian example

“…Paradoxically, populations experiencing disadvantage who have the highest need for health and social services are the least likely to access them; this phenomenon is known as the inverse care law. [8][9][10] Disadvantaged groups often fall through the cracks in a health system poorly suited to meet their needs; by the time vulnerable children access services their concerns have typically escalated, increasing their risk of adverse lifelong health and wellbeing outcomes. [11][12][13] SIH models aim to reduce barriers by providing affordable health care to families in locations that are familiar and convenient.…”