When children are the patients, health care spending calls for unique considerations

Across Canada, health care institutions are increasingly under pressure to stretch resources and shrewdly allocate funds in ways that result in positive health outcomes for patients. A study co-authored by Vancouver Coastal Health Research Institute scientists Dr. Craig Mitton and Neale Smith highlights how those decision-making processes change, and are subject to unique considerations, when the patients receiving the care are children: “Children are not simply small adults -- providing them with proper care typically requires additional time, specialized skills and equipment, and can be a highly emotional endeavour.” 

“Without careful attention, healthcare organizations may put in place priority setting and resource allocation processes that may inadvertently disadvantage child and youth health.”

Published in Healthcare Quarterly, the Canadian Institutes of Health Research-funded study was a policy analysis project initiated by the IWK (Izaak Walton Killam) Health Centre in Halifax, Nova Scotia. The centre had previously worked with Dr. Mitton, a senior scientist at the Centre for Clinical Epidemiology and Evaluation (C2E2) and professor in the School of Population and Public Health in the Faculty of Medicine at the University of British Columbia, to set up a priority setting and resource allocation (PSRA) process to help make decisions about how to spend resources. The subsequent policy analysis allowed the IWK Centre to better ensure that their processes recognized the features distinctive to pediatric care. 

Effective PSRA processes focusing on pediatric care offer significant future savings

PSRA processes are intended to ensure that health care institutions are getting the best value for their dollar so that the money being spent in the health care system is going to the kinds of programs and services that have demonstrated the biggest returns for the patients in terms of health outcomes. An even greater return on health care investment is possible when funds are adequately and appropriately put into child health services up front as it potentially saves the health care system from having to spend on care later in a child’s life.

According to the authors, “Early investment provides an economic pay-off for society in terms of increased future productivity and societal contribution from children who have received healthcare services at an early and crucial stage in life¹. And children who grow up healthier can be expected to exhibit decreased long-term health service utilization.”

‘Made-for-child-health’ lens refocuses how to decide on health care spending

“We sought to identify the unique features of pediatric health that should be considered when trying to build a system to allocate resources within the health care organization,” says Smith, a research coordinator with C2E2. 

“We boiled it down to three themes and created a ‘made-for-child-health’ lens that raises sensitizing questions for similar health care organizations to ask themselves.”

First, children and youth populations are diverse. Neo-natal patients are different from toddlers, who are different from adolescents, and so forth. Child and youth health service organizations are trying to meet the needs of these diverse patients with relatively small numbers within each age group at any given time, making it difficult to achieve economies of scale.

“An example given is spending for hospital gowns,” says Smith. “You need different sizes for children’s hospital gowns versus having the ability to buy in bulk for adult sizes.”

Second, it takes a long time to measure the benefits of child and health services, which affects the ability of decision-makers to produce a full evidence-based accounting of all their costs and benefits.

Finally, there exist difficulties around engaging child and youth patient populations to contribute to decision-making around both their own care, and organizational and system levels questions about resource allocation.

“Based on our consultations with children’s hospitals across the country, these are the points they think are distinctive about their setting,” says Smith. “Because of this project, such health facilities can now think of these themes when they’re building a PSRA process to make sure they don’t unintentionally set up something that’s going to lead to these kinds of issues not being seen.”

“The folks at the IWK Health Centre got the ball rolling by first taking the effort to improve priority setting, and then second, they took this info the formal research world by bringing in academic partners,” he says. “They deserve due credit and kudos for their leadership.”

¹ 15 by 15: A comprehensive policy framework for early human capital investment in BC