The effect of user charges and socio-demographic environment on paediatric trauma hospitalisation in Helsinki in 1989-1994.

Although many studies have shown an association between socio-economic environment and childhood injury mortality rates, little research has focused on the association between injuries which require hospitalisation and the child's socio-economic environment. All municipal emergency care was free of charge before the beginning of 1991, from then on a moderate patient charge was introduced by the City of Helsinki. An earlier report from a completely different social environment suggest that even a moderate user charge might create systematic discrimination against indigent families. We studied the childhood injury hospitalisation rates during 1989-1994 in Helsinki and analysed the association between rates of hospitalisation and local socio-economic and demographic factors. We also examined the effect of introduction of emergency room user charges on the rate of hospitalisation. Data from 1607 injuries from Helsinki City Hospital and 769 injuries from Helsinki University Central Hospital from years 1989 through 1994 were used. Annual rates of child hospitalisation were calculated at city level. Local socio-economic and demographic variables were derived from the Helsinki Bureau of Statistics. The possible association between the explanatory variables and hospitalisation rates at Helsinki City Hospital was calculated using annual data from the 33 health districts in Helsinki. The overall rate of hospitalisation for injuries declined but not statistically significantly. No association between socio-economic and demographic variables and hospitalisation rates was found. The moderate user charge had no effect on hospitalisation rates, proving that, in this setting, the demand for care was rather inelastic in paediatric injuries severe enough to require hospitalisation.

Impact of user charges and socio-economic environment on visits to paediatric trauma unit in Finland.

In this report we (i) measure the strength of the association between paediatric trauma visit rates and regional socioeconomic and demographic variables, and (ii) quantify any selective impact of user charges on service demand in socioeconomically and demographically different areas. During the period 1989-94, a total of 30,362 home and leisure injury visits were made to the Aurora City Hospital. The visit rates are analysed using a random effects model. In addition, the areas are ranked into three groups in accordance with a socioeconomic index measure, and the annual visit rates of the three groups are calculated. We found fairly minor differences in children's visit rates between unequal socioeconomic areas, and it is apparent that socioeconomic status cannot explain the change in visit rates as a result of the introduction of user charges. We speculate that these changes in emergency visit rates will not lead to long-term health problems among any segment of the city population.

User charges and the demand for acute paediatric traumatology services.

The city of Helsinki in 1991 introduced moderate patient charges for certain acute paediatric services. This provided the framework for a natural, partially controlled experiment on price elasticity of demand for acute paediatric trauma services. A cross-sectional time-series analysis of a partially controlled natural experiment was done for the period 1989-1994. The findings suggest that moderate user charges may reduce the demand for paediatric trauma services measurably. The effect was diagnosis-specific and, on average, stronger in older than in pre-school children. It probably had a negligible impact on long-term health.

The socio-economic and demographic context of children's emergency injury visits in Helsinki in 1991-1994.

The aim is to study the association between age- and diagnosis-specific trauma visit rates and socio-economic and demographic variables in the city of Helsinki, Finland. A total of 19,772 home and leisure injury visits were analysed by random effects (REM) and Poisson regression models. Visit rates were calculated for age- and diagnosis-specific groups for each of the city's 33 health districts using the corresponding age-specific census data. In addition, the areas were ranked into three groups according to a socio-economic index measure. The annual visit rates of the three groups were calculated and the effect of distance on visit rates by socio-economic groups was analysed. In the case of pre-school children no correlation was found between explanatory variables and trauma visit rates. In the school-aged children group distance from the hospital (p < 0.001) correlated with childhood ambulatory visit rates. We found a rather modest difference in children's visit rates between unequal socio-economic areas. However, the demand for care was elastic for travelling distance (p < 0.05) in poorer suburbs but not in more affluent areas in the case of school-aged children. The probability of significant inequalities in children's trauma visit rates was small in Helsinki during 1991-94.