Did the invisible hand rock the cradle? An investigation of children's hospitalisations in New Zealand.

OBJECTIVES

To test the hypothesis that the overall growth in children's hospitalisations since the instigation of New Zealand's economic and social reforms in 1984 reflects an increase in morbidity caused by socio-economic factors such as poverty, unemployment, household overcrowding and the cost of primary care.

METHODS

All publicly funded hospitalisations amongst children aged 1-14 years, for the years 1988/89 to 2002/03, were categorised as either avoidable or unavoidable based on primary discharge diagnosis. Trends in avoidable and unavoidable hospitalisation rates over time and for various demographic and socio-economic groups were analysed.

RESULTS

Growth in avoidable and unavoidable hospitalisations amongst children was similar over the period, with unavoidable hospitalisations growing slightly faster. Growth in avoidable hospitalisations was greatest for children who live in the least deprived areas and lowest for children who live in the most deprived areas. Making primary care substantially free for children aged less than six years did not appear to slow the growth in avoidable hospitalisations.

CONCLUSIONS

Trends in avoidable and unavoidable hospitalisations over time are not consistent with the hypothesis being tested. The available evidence does not support a link between morbidity attributable to socio-economic factors and growth in children's hospitalisations. Given the lack of other evidence for deterioration in overall child health, the available evidence does not support a link between economic and social reforms in New Zealand and a decline in children's health status.