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.