Bulletin

Issue: October 2005

News

Children's healthcare: one size does not fit all

Health care providers should do more to recognise the needs of the 21st century family, according to La Trobe University researcher, Dr Fiona Andrews.

General practitioners, health centres, dentists, and others should all become more flexible because of evidence that some children's health may be at risk because they have difficulty accessing services.

This is because over the last 50 years there have been significant changes in families' working arrangements with the growing trend for women returning to paid work after the birth of their children.

Balancing the needs of work and family has become a subject of much debate. For example, Prime Minister John Howard, describes it as: 'the biggest ongoing social debate of our time...a barbeque stopper.'

But, says Dr Andrews, the situation is far from simple because the problem of child health care is not the same for all families.

'We know that pre-school children are the second greatest users of health care after people aged 65 and over.

'Young kids are susceptible to frequent episodes of minor ill health as well as requiring preventative health care such as immunisation and regular health assessments to detect any developmental delay. But we don't know very much about how families manage this health care.'

Dr Andrews is a project officer for the Australian Institute for Primary Care housed at La Trobe's main Melbourne campus at Bundoora and also lectures in the School of Public Health. She holds a PhD in biomedical research, but studied the needs of mothers in the City of Whittlesea as her research project for the Master of Health Science degree.

For this she conducted in-depth interviews with 15 mothers, seven working 30 hours or more each week and eight at home full-time, each with at least one child under five years of age.

She found that a number of the mothers had difficulty in accessing health services but the reasons for this, which included time and financial constraints, were diverse. The health services included not only GPs, maternal and child health nurses and dentists but also allied health practitioners such as speech pathologists and audiologists.

Some working mothers were unable to take their children to health care providers through lack of time during the day, suggesting that more after-hours services were desirable. Others, at home full time, failed to access health care because they could not afford it, suggesting the need for more bulk billing and other low cost services.

'I need to emphasise that my research took place in one municipality, and a growth corridor at that, and that the information acquired reflected the situation in late 2003 and early 2004 when the interviews took place,' Dr Andrews said.

After interviewing the 15 women, all of whom had similar non-professional backgrounds, Dr Andrews found they fell into three general categories.

The first, which comprised five women - all paid workers - had limited time to take their children to health care providers, attempting when possible to use services available after working hours. However, often they could not access services, particularly Maternal and Child Health and allied health services. A major reason was that only a limited number of clinics opened after hours.

A second group - four mothers at home - had limited finances for health care. Because their family had only one income they were restricted to using GPs who bulk billed and for this reason often could not see the same GP. Through lack of money, one mother even had to use a hospital emergency facility. Women were frustrated that, because of financial constraints, their children were not receiving continuity of care. Dentists and other allied health professionals were too expensive for several in this group.

The third comprised six women - two paid workers and four at home - who were able to be involved when their children were unwell and could access health care providers. These women tended to have more supportive workplaces which provided time off and received more support from their husbands than other women in the study. In addition, these women spoke of 'choosing' to be in paid work or at home full-time.

In contrast, those in the first two groups tended to have less support and were dissatisfied with their decisions either to be at home full-time or in paid work. These women spoke of 'having' to work for financial reasons or wanting to work but not being able to find a job or affordable child care.

'It all adds up to a need for more family friendly health services. Health care providers, subject like all of us to political and work issues, should respond to the need of contemporary families while realising that family needs are different and that "one size does not fit all",' Dr Andrews concluded.