Issue 46 / 5 December 2011

IT’S a generally accepted principle in preventive health that carrots work better than sticks — giving people an incentive to adopt a desirable behaviour is likely to be more effective than punishing them for an undesirable one.

So why has the federal government decided to switch from rewards to sanctions when it comes to childhood immunisation?

The short answer is $200 million, the amount it expects to save over 4 years as a result of its decision to dump the maternity immunisation allowance, currently paid in two instalments of $129 to parents who immunise their children.

From 1 July next year, it will instead take a new punitive approach that will see parents who don’t comply with the immunisation schedule lose the family tax benefit part A — a cost of just over $2100 per child in lost benefits.

Now, I’m all in favour of measures that boost immunisation rates but I wonder if these changes will actually do that, despite the government’s claimed motivation of creating a “stronger financial incentive” for parents to immunise.

A discussion paper on the use of financial incentives in health, commissioned by the National Health and Hospitals Reform Commission, found that rewarding positive health behaviours with financial incentives appeared more likely to be effective than penalising negative ones.

“Financial penalties should be used with caution, as they may penalise the least well off, who may be most in need of preventive care”, wrote the authors from the Melbourne Institute of Applied Economic and Social Research.

It’s hard to know just how effective the immunisation allowance has been, as it’s pretty well impossible to disentangle its effects from those of the incentives paid to GPs for ensuring children are immunised (the GP incentives will continue under the new system).

So, maybe it’s no great loss, especially given that the payment never actually required parents to immunise their children at all.

Bizarrely, parents still received the money if they registered a formal conscientious objection to immunisation based on a “personal, philosophical, religious or medical” belief.

That exemption will remain in place under the new arrangements. In fact, there’s more justification for it under a punitive system than there was under a rewards-based one.

Of course, the most vehement opponents of vaccination would hardly have changed their minds for financial reasons, even without that exemption. So who is likely to be affected by the new approach?

Chances are it will be children living on the edge, those in chaotic or dysfunctional families, those who don’t receive regular medical care and whose parents are certainly not going to visit a GP to make a conscientious objection.

In other words, “the least well off, who may be in most need of preventive care”.

Jane McCredie is a Sydney-based science and medicine writer.

Posted 5 December 2011

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3 thoughts on “Jane McCredie: Wielding a blunt stick

  1. Janet Hutchison says:

    Hi Jane, Who are you calling dysfunctional? It is probably inevitable that women with ADHD will be over-represented amongst those who don’t keep up with their children’s immunisation schedules. Yet most women who have ADHD don’t even know they have it. Who’s fault is this? Doctors have known about the first line treatment for children and adults with ADHD since the late 1930s. Seems like doctors are pretty dysfunctional to me.
    Question is, if these mothers find out about their ADHD too late to get their family benefits paid back by the government, will their dysfunctional/negligent doctors compensate them instead. BTW, I recommend not bandying about the word dysfunctional too freely.

  2. Anonymous says:

    Totally irrelevant as like all Ms Gillard’s previous work it is a lie There is a “conscientious objection”clause included that effectively negates the legislation. This merely to impress the gullible, not alter the status quo

  3. Janet Hutchison says:

    The point that Jane McCredie makes is that this legislation will trip up those who for reasons other than conscientious objection will not keep up with immunisation schedules. I agree with that. In fact, I’m appalled that doctor visits are taken up with admin tasks such as receipt of conscientious objection statements. Let’s forget about the conscientious objectors and help out – not punish – those who genuinely want their children immunised but are falling behind. Regulations such as these that are very likely to disproportionately catch out people with unrecognised disabilities are clearly discriminatory. However, they would be less discriminatory if health providers, including doctors, would do their job and diagnose and treat disabilities, including ADHD in particular.

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