Letters
Health services administration
Volume 195 - Issue 6

The costs of preschool communication problems

Authors:  Jemma Skeat, Lisa Gold, Melissa Wake, Obioha C Ukoumunne and Sheena Reilly

Med J Aust 2011; 195 (6): 322-323. || doi: 10.5694/mja11.10254
Published online: 19 September 2011
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To the Editor: Childhood communication disorders (CCD) affect up to 20% of 4-year-old children.1 Early intervention is important2 and a variety of health and education professionals may provide assistance, including speech pathologists (SPs), paediatricians, general practitioners and others. The type and amount of help provided to preschool-aged children in Australia is unknown, nor are the costs empirically described. Using data from the Early Language in Victoria Study (ELVS),1,3 a prospective study of a large Australian cohort of children, we describe the use of services for CCD, out-of-pocket costs to families and costs to the health system.

ELVS participants were recruited at 8 months of age, at routine child health checks in maternal and child health centres in Melbourne during 2002. Parents completed questionnaires at baseline (when the child was 8 months of age) and at each birthday.3 In-depth questions about use of services were included for the first time at 5 years. These questions covered SP assessment and treatment, visits to other professionals for CCD concerns, and out-of-pocket expenses for all services, within the preceding 12 months (ie, when children were in their fourth year).

Of the original cohort, 983 families (51%) completed the service-use questionnaire. Sixteen per cent had used services (one-third of whom used more than one service); 11% had accessed SP treatment, and 6% had accessed other professionals. The number of service occasions per year for each professional, and the associated costs, are shown in the Box. Children accessing SP treatment received a median of 10.8 therapy hours within 12 months (interquartile range, 4.3–17.3; range, 0.5–104); 28% received ≤ 5 hours and 13% received > 25 hours. Costs of all services accessed in the period, including health system costs and parent out-of-pocket expenses, varied from $34 to $16 546.

Our data show that some children received very little intervention for CCD within a 12-month period. Given the critical importance of communication skills to school achievement, this is of concern. We also demonstrate a substantial financial outlay associated with the treatment of CCD in Australia. These data are likely to be generalisable given the nature of this prospective cohort and the reliability of our health care cost estimates. The results highlight the immense variability in service use and the potential burden of cost to government and families associated with CCD. Our data do not describe service use before 4 years of age, nor have we included indirect costs such as travel and parental time away from work. Thus, they represent a starting place for understanding total costs.

Costs to the health care system and families for childhood communication disorders services provided to children aged between 4 and 5 years in the Early Language in Victoria Study cohort

Cost per family for 1 year using the service

Service

Median number of visits per year (IQR; range)

Health care system cost* per visit ($)

Median health care system cost ($) (IQR; range)

Median out-of-pocket costs ($) (IQR; range)

Median combined costs (health care system + out-of-pocket) ($) (IQR; range)

Speech pathologist (treatment)

15.2 (6.5–26; 1–52)

49

742 (318–1273; 49–2545)

498 (173–1040; 0–4117)

1061 (472–2256; 49–6662)

Paediatrician

2 (1–3; 1–10)

119 (initial) 59 (subsequent)

178 (119–237; 119–296)

250 (120–320; 0–500)

328 (178–511; 119–776)

General practitioner

2 (1–4; 1–10)

34 (standard)

67 (34–151; 34–336)

40 (0–75; 0–294)

101 (34–181; 34–495)

Psychologist

3 (1.5–4.5; 1–8)

49

147 (61–233; 49–392)

575 (105–889; 0–1300)

502 (157–1027; 49–1545)

Otolaryngologist

2 (1–3; 1–8)

119 (initial) 59 (subsequent)

178 (119–237; 119–534)

210 (120–358; 65–1200)

239 (119–438; 119–1734)

Hearing specialist

1 (1–2; 1–4)

49

49 (49–98; 49–196)

0 (0–2; 0–1000)

50 (49–98; 49–1098)

Early intervention†

10 (1.5–28; 1–48)

240

2400 (300–8160; 240–11 520)

112 (0–600; 0–720)

2400 (300–8638; 240–12 240)

All services

na

na

661 (238–1273; 34–14 426)

413 (91–1306; 0–4500)

1061 (335–2460; 34–16 546)

IQR = interquartile range. na = not available. * Health care system costs were Medicare Benefits Schedule (MBS) fee rates charged at the applicable rebatable level (ie, 100% for GP services and 85% for other services).4 † Early intervention services, which are not covered by the MBS, were estimated from existing cost estimates.5

Authors

  • Jemma Skeat1
  • Lisa Gold2
  • Melissa Wake1
  • Obioha C Ukoumunne3
  • Sheena Reilly1
  • 1. Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne, VIC.
  • 2. Population Health Strategic Research Council, Deakin University, Melbourne, VIC.
  • 3. Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, UK.

Correspondence: jemma.skeat@mcri.edu.au

Competing interests

No relevant disclosures.

Acknowledgements

Research at the Murdoch Childrens Research Institute (MCRI) is supported by the Victorian Government Operational Infrastructure Support Program. Our study is supported by project grants from the National Health and Medical Research Council (NHMRC) and small grants from MCRI and La Trobe University. NHMRC grants support Jemma Skeat (Population Health Capacity Building Grant), Melissa Wake (Population Health Career Development Grants) and Sheena Reilly (Practitioner Research Fellowship).

References

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