Preventive child health care at elementary school age: The costs of routine assessments with a triage approach

Abstract

BackgroundTriage in Preventive Child Health Care (PCH) assessments could further the efficient use of human resources and budgets and therefore make extra care possible for children with specific needs. We assessed the costs of routine PCH assessments with and without triage for children aged 5/6 years and 10/11 years. In a triage approach, PCH assistants conduct pre-assessments to identify children requiring follow-up assessments by a physician or nurse. In the usual approach, all children are assessed by a physician and an assistant (children aged 5/6 years) or a nurse (children aged 10/11 years).MethodsAll the direct costs of conducting routine PCH assessments with the triage and usual approach were assessed using a bottom-up micro-costing approach. In four PCH services in the Netherlands, two using triage and two the usual approach, professionals completed questionnaires about time spent on assessments, including time related to non-attendance at assessments, the referral of children and administration.ResultsThe projected costs for PCH professionals working on PCH assessments amounted to €5.2 million per cohort of 100,000 children aged 5/6 years in the triage approach, and €7.6 million in the usual approach. The projected costs in both approaches for children aged 10/11 years were about €4 million per 100,000 children.ConclusionThe triage approach to PCH resulted in a projected cost reduction of about one-third, compared with usual practice, for routine assessments by physicians of children aged 5/6 years. There are minimal cost savings in the group of children aged 10/11 years when nurses are involved and so other considerations such as workforce shortages would be required to justify a change to a triage approach. Further research is needed to investigate the differences in costs of care after the completion of the routine assessments.

Triage in preventive child healthcare: a prospective cohort study of care use and referral rates for children at risk

“…20 Our study of the costs of the routine assessments in the two approaches showed that the triage approach resulted in a cost reduction of about one-third for the age group of 5 to 6 years and a minimal cost reduction for the age group of 10 to 11 years. 21 This study examined the impact of triage and task shifting on care for children at risk who were identified by PCH or by external parties such as parents and schools. It addresses the following research questions:…”