Child health checks and welfare conditionality: a check-up

Parliament house flag post

Child health checks and welfare conditionality: a check-up

Posted 27/05/2011 by Luke Buckmaster

Line drawing of a child with a yoyo
The Government recently added child health checks to its welfare reform agenda by announcing that it would require parents of four year olds to provide evidence that their child has had a basic health assessment in order to receive the Family Tax Benefit Part A Supplement.

However, the Rudd-Gillard Government's experience to date with child health checks has been the subject of criticism by some medical experts and health sector commentators, raising questions about the likely effectiveness of the policy.

Healthy Kids Check

Child health assessments were first introduced by the Rudd Government in July 2008 through the creation of Healthy Kids Check item numbers on Medicare. According to a Department of Health and Ageing fact sheet, the aim of the Healthy Kids Check is:
... to improve the health and well-being of Australian children. The Healthy Kids Check promotes early detection of lifestyle risk factors, delayed development and illness, and provides the opportunity to introduce guidance for healthy lifestyles and early intervention strategies.
Healthy Kids Check must include assessments of height, weight, eyesight, hearing, oral health, toileting and allergies. They are intended to be delivered in conjunction with the four year old immunisation.

As noted above, the Government intends making the payment of the Family Tax Benefit Part A Supplement (currently $726.35 per child) for a child turning four in a particular income year, conditional on the child having received a basic health assessment. This measure is also the subject of a Bill currently before the Parliament.

The Government’s rationale (p. 24) for linking payment of the Part A Supplement to a child health check is that such checks 'may detect developmental delays and conditions, such as problems affecting hearing and vision, which are problems that make it more difficult for children to learn when they start school'. The Government has also argued that child health checks are particularly important for people on low incomes because of research indicating that disadvantaged children arrive at school less well prepared and that this disadvantage persists, and even widens, as children progress through school.

The Bill does not establish precisely what health checks are to be required under this measure—these are to be set by Ministerial determination. However, it would be reasonable to assume that the Government intends that child health checks required under this measure will largely be provided under the existing Healthy Kids Check Medicare items.

This link of the Part A Supplement to child health checks reflects the increasing use by the Labor Government of ‘welfare conditionality’ as a way of addressing some of the harmful effects of welfare dependency. (I have previously discussed this aspect of Labor's approach to social policy here and here).

Criticisms of the Healthy Kids Check

Low uptake
To date, uptake of the Healthy Kids Check program has been relatively low. Lesley Russell of the Menzies Centre for Health Policy has shown that, in the first two years following its introduction, only 81 463 Healthy Kids Checks were done, at a cost of $3.79 million. Russell noted that this was ‘well below what was anticipated for a nation with some 260 000 four-year olds, and a program that was budgeted to cost $25.6 million over four years’.

Further, Medicare data shows that since the introduction of new item numbers and descriptors for the checks in May 2010, around 57 417 services were provided to children in the age group targeted by the Healthy Kids Checks. While this does suggest a modest increase in numbers of children undergoing health checks (achieved over just a 10 month period), arguably, it still represents a less-than-substantial uptake of the program. It may be that linking the Part A Supplement to receipt of a child health check is intended to increase uptake of the Healthy Kids Checks.

Evidence and effectiveness
Critics have also argued that the evidence base for the Healthy Kids Checks is inadequate. For example, an April 2010 paper in the Medical Journal of Australia found that 'the evidence behind the [Healthy Kids Check] is not compelling'; 'its components are ill defined and lack rationale' and 'could be refined to better reflect the available evidence'.

A further criticism has been that evidence suggests the need for health checks to take place earlier in a child’s development than four years old. It has been reported that, as part of the Budget mental health package, the Government expanded the child health checks measure to include three year olds and that this had been welcomed by some doctors. However, the relevant Government fact sheet makes it clear that Healthy Kids Checks have been available to three year olds since at least May 2010 (the fact sheet refers to children being eligible for the scheme if they are ‘over the age of three years and under the age of five years’). However, some medical experts suggest that the checks should be carried out earlier than this and on a more ongoing basis (see also here).

There has also been criticism that the Healthy Kids Check program does not include any requirement for follow-up or ongoing treatment for health problems identified in a health check. According to critics, the one-off nature of the checks reduces the potential effectiveness of the program. As Russell argues, ‘there is nothing to require that children get the follow-up medical care, eyeglasses, hearing assistance or speech therapy they might need’.

Should the checks be run through Medicare?
Of the criticisms outlined above, those relating to follow-up and evidence are fundamental and raise questions about the overall effectiveness of the program. However, the concerns relating to low uptake of the program may also highlight a question of fundamental significance. That is, whether Medicare provides the most suitable way of screening young children for health problems.

One problem with running child health checks through Medicare is that often there is a cost for care. There is substantial evidence that financial barriers prevent access to necessary care (for example, see here and here). While it could be expected that a reasonable proportion of Healthy Kids Checks would be bulk-billed, there would still be financial barriers arising from the need to access treatment for any problems identified. As noted above, the Healthy Kids Checks do not provide for this and many of the services children might need only receive limited funding through Medicare (for example, speech pathology, occupational therapy or physiotherapy).

A further problem with running the program though Medicare is that it assumes that people on low incomes are easily able to access GPs. However, there is evidence that this is not actually the case and that GP services are subject to what is known as the inverse care law, where medical care is least likely to reach those most in need. For example, we know that compared with people in areas of least disadvantage, GP consultations with people from socially disadvantaged groups are shorter and less likely to result in an investigation or referral (for example, see here, here and here).

Finally, there is the issue of whether Medicare (an insurance based system providing rebates for acute fee-for-service medical consultations) is an appropriate model for providing preventive care or care for chronic conditions. Some experts argue that more integrated, coordinated and personalised models might be more effective (see also here). The Government made some moves away from fee-for-service medicine with its 2010 Budget proposal to give GPs block grants for each voluntarily enrolled patient with diabetes, to manage and coordinate all their health care needs (though, this has since been deferred in favour of a pilot scheme following opposition from the Australian Medical Association).


The Government's welfare conditionality reform agenda is now fairly well established and will continue to attract both criticism and support from within the welfare sector. Clearly, though, it is important that any activity on which receipt of welfare is made conditional is based on solid evidence and is likely to be effective. Concerns about aspects of the Medicare Healthy Kids Checks highlight the importance of making sure that this is the case.

(Image sourced from: Queensland Health;

Thank you for your comment. If it does not require moderation, it will appear shortly.

Add your comment

[Click to expand]

We welcome your comments, or additional information which is relevant to a post. These can be added by clicking on the ‘Add your comment’ option above. Please note that the Parliamentary Library will moderate comments, and reserves the right not to publish comments that are inconsistent with the objectives of FlagPost. This includes comments that are not relevant to the article, factually incorrect or politically partisan, as well as spam, profanity and personal abuse. We will close comments after three months.

Generate a new image
Type characters from the image:

Facebook LinkedIn Twitter Add | Email Print


Flagpost is a blog on current issues of interest to members of the Australian Parliament

Parliamentary Library Logo showing Information Analysis & Advice




Refugees asylum immigration climate change Australian foreign policy Parliament social security elections welfare reform welfare policy school education Australian Defence Force health financing indigenous Australians women Private health insurance higher education emissions trading people trafficking Middle East taxation Employment illicit drugs gambling health reform federal election 2010 Medicare disability Sport Australian Bureau of Statistics statistics United Nations Asia criminal law Afghanistan income management health forced labour Australian Sports Anti-Doping Agency World Anti-Doping Agency United States federal budget Industrial Relations Carbon Pricing Mechanism politics dental health Australian Public Service constitution Australian Electoral Commission WADA transport aid child protection environment poker machines Australia in the Asian Century steroids National Disability Insurance Scheme detention aged care 43rd Parliament slavery health system OECD ASADA Law Enforcement Australian Federal Police Fair Work Act governance labour force people smuggling debt international relations New Zealand food Australian Crime Commission pharmaceutical benefits scheme banking International Women's Day corruption pensions public service reform children's health Aviation federal election 2013 foreign debt gross debt net debt defence capability parliamentary procedure Senate Senators and Members ALP Newstart Parenting Payment multiculturalism Youth Allowance sea farers High Court skilled migration UK Parliament election results voting mental health Federal Court terrorist groups science social media Higher Education Loan Program HECS federal state relations accountability Papua New Guinea youth paid parental leave same sex relationships coal seam gas customs planning doping crime health risks Gonski Review of Funding for Schooling sex slavery Special Rapporteur Northern Territory Emergency Response social policy firearms public policy Census Population violence against women domestic violence China ADRV terrorism transparency research and development welfare ASIO intelligence community Australian Security Intelligence Organisation carbon tax mining military history electoral reform employer employee renewable energy regional unemployment fishing by-election European Union family assistance United Nations Security Council Australian economy forestry food labelling vocational education and training Drugs welfare systems Indonesia children Constitutional reform local government codes of conduct terrorist financing homelessness Parliamentary remuneration money laundering Trafficking in Persons Report energy social inclusion human rights paternalism early childhood education Canada Financial sector national security fuel disability employment Tasmania integrity standards NATO Australian Secret Intelligence Service sexual abuse World Trade Organization Australia public health housing affordability bulk billing political parties water productivity health policy Governor-General US economy trade unions export liquefied natural gas foreign bribery question time speaker superannuation public housing expertise climate Intergovernmental Panel on Climate Change leadership Department of Agriculture Fisheries and Forestry regulation Pacific Islands reserved seats new psychoactive substances synthetic drugs UNODC carbon markets animal health middle class welfare Indigenous constitutional recognition of local government referendum consumer laws PISA competition policy royal commission US politics language education baby bonus Leaders of the Opposition citizen engagement policymaking Australia Greens servitude Trafficking Protocol forced marriage rural and regional alcohol entitlements ministries Hung Parliament social citizenship maritime Iran ANZUS regional students school chaplains federal budget 2011-12 salary Medicare Locals primary care Building the Education Revolution procurement Indigenous health e-voting internet voting nsw state elections 44th Parliament 2015 ABS Age Pension Death penalty capital punishment execution Bali nine Bali bombings Trade EU China soft power education Fiji India Disability Support Pension Antarctica Diplomacy by-elections state and territories Bills anti-corruption fraud bribery corporate ownership whistleblower G20 economic reform innovation Members of Parliament Scottish referendum Middle East; national security; terrorism social services Criminal Code Amendment (Misrepresentation of Age to a Minor) Bill 2013 online grooming sexual assault of minors ACT Assembly smoking plain packaging tobacco cigarettes Asia; Japan; international relations Work Health and Safety Migration; asylum seekers; regional processing China; United States; international relations fiscal policy Racial Discrimination Act; social policy; human rights; indigenous Australians Foreign policy Southeast Asia Israel Palestine asylum refugees immigration political finance donations foreign aid Economics efficiency human rights; Racial Discrimination Act employment law bullying asylum seekers Animal law; food copyright Australian Law Reform Commission industry peace keeping contracts workplace policies same-sex marriage disorderly conduct retirement Parliament House standing orders prime ministers election timetable sitting days First speech defence budget submarines workers Somalia United Kingdom GDP world heritage political engagement leave loading Trade; tariffs; safeguards; Anti-dumping public interest disclosure whistleblowing Productivity Commission limitation period universities Ireland cancer gene patents genetic testing suspension of standing and sessional orders live exports infant mortality honorary citizen railways disciplinary tribunals standard of proof World Health Organisation arts international students skilled graduate visas temporary employment visas apologies roads Italy national heritage NHMRC nutrition anti-dumping Rent Assistance obesity evidence law sacrament of confession US presidential election international days DFAT UN General Assembly deregulation Regulation Impact Statements administrative law small business Breaker Morant regional engagement social determinants of health abortion Members suspension workplace health and safety marine reserves hearing TAFE Victoria astronomy resources sector YMCA youth parliament Korea rebate Australian Greens presidential nomination Racial Discrimination Act political parties preselection solar hot water Financial Action Taskforce Horn of Africa peacekeeping piracy Great Barrier Reef Stronger futures political financing political education Social Inclusion Board early childhood National Quality Framework for Early Childhood Education and Care Murray-Darling Basin sanctions Norway hospitals republic President Barack Obama Presidential visits qantas counselling Korean peninsula Work Choices biosecurity hendra environmental law federalism federation preselection therapeutic goods Therapeutic Goods Administration plebiscites computer games pests suicide nuclear COAG Ministerial Councils floods ADHD stimulant medication advertising electricity extradition conscience votes poverty preventative health rural health coastal erosion Parliamentary Budget Office work-life balance

Show all
Show less
Back to top