Children Welfare Service Intervention-Differences in Healthcare Utilization in Young Children in Taiwan

Introduction: Young children are at greater risk for unfavorable health and developmental outcomes when family or parents experienced certain adverse/disadvantaged conditions (e.g., financial difficulty, parental incarceration, or untreated substance use disorders). Identification of those families at-risk and provision of timely family-based intervention are a priority for child welfare services (CWS) to facilitate children’s better growth/development and reduce subsequent maltreatment. The present study aims to investigate the CWS intervention-related differences in healthcare utilization in young children and examine potential explanatory factors.

Methods: Based on the National Client Data of High-Risk Family’s Child and Youth in Taiwan, we initially identified 5308 0-6 year-old children who received the high-risk family intervention by CWS during the calendar years of 2012-2015. Next, for comparison, 53080 children were randomly selected with the matching criteria of birth year/month, gender, and residence from the National Health Insurance Research Database (NHIRD). Information concerning healthcare utilization in outpatient, inpatient, and emergence department in the year before and after the CWS intervention was ascertained from the NHIRD. Differences-in-differences methods were used to explore utilization differences and associated individual sociodemographic and health predictors.

Results: In the year preceding the CWS’ high-risk family intervention, the proportion of outpatient, emergency room, and inpatient cares utilization was 89.4%, 38.9%, and 17.5%, and the corresponding estimates were 91.5%, 27.4%, and 10.3% in their matched counterparts. After the CWS intervention, the percentage of outpatient and emergency room care was accordingly increased by 8.7% and 6.7% (vs. 8.0% and 19.0% in matched children), whereas inpatient care was reduced by 8.57% (vs. increased by 9.7% for matched children). The intervention-differences in healthcare utilization was not observed across subgroups defined by individual sociodemographic characteristics and health conditions (e.g., infancy) and family attributes (e.g., primary cause of high-risk family intervention).

Conclusions: The collaboration between CWS and healthcare is urgently needed to address the unmet needs in healthcare and reduce negative health/developmental consequences among young children from families experiencing adverse/disadvantaged conditions.