For Aboriginal families living in remote locations, having Medicare is not enough when getting medical help for severe burns in children.
Financial stress is common among Aboriginal families living in remote locations, when having to find medical help for children with severe burns. This is one of the key findings of a new study from researchers at Flinders University, who found that some families had to skip meals or sell assets in order to cover expenses related to their child’s treatment.
The study, led by Dr Courtney Ryder and Associate Professor Tamara Mackean, both from the College of Medicine and Public Health at Flinders University.
According to the most recent national figures, more than 5,400 cases of hospitalised burn injuries were reported between 2013-2014. Among these cases, nearly 10% involved Aboriginal and Torres Strait Islander people and burns were more common in the youngest Aboriginal and Torres Strait Islander age group, children between 0 and 4 years of age.
A previous study by Dr Ryder showed that Aboriginal and Torres Strait Islander children are admitted, on average, three times more often than non-Indigenous children and spent four days longer in the hospital than other Australian children, when dealing with severe burns. The risk of infection was also higher in Aboriginal and Torres Strait Islander children, compared to other Australian children. “Streptococcus sp. infection risk was 4 times greater in Aboriginal and Torres Strait Islander children compared to other Australian children,” the authors wrote in their report.
This increased rate of infection is influenced by multiple factors, such as the type of burn, percentage of the body affected, and the distance travelled to reach a health care facility. Flame burns, high percentage body surface area and rural residency are all factors associated with Streptococcus infections, Dr Ryder explains. “…60% of Aboriginal and Torres Strait Islander children with a burn injury resided in outer regional to remote areas. In these regions contact and flame burns are more common,” she said.
Delays in treatment and lack of specialist service also influence the health and financial outcomes of children with severe burns. “Delays in burn treatment also impact on the optimal application window for some burns treatment i.e. BiobraneTM. Streptococcus infection is of particular concern, as it requires treatment before grafting, else burn grafts will be rejected, this in turn increases length of hospital stay impacting on out-of-pocket costs,” Dr Ryder explained.
Now, in this new study, Dr Ryder’s team found that the economic impact of treating children with burns was highest in families who live in rural areas. In some cases, families had to travel more than five hours to reach a health care facility and had to skip meals or sell assets to help cover expenses.
About the study
For their analysis, researchers met with six families from South Australia, New South Wales and Queensland, through four yarning sessions, where families discussed their experiences with out-of-pocket expenses related to burn treatment in their children. These children had sustained severe burns, requiring at least one overnight stay at a hospital.
One of the key findings of this study was that remote families incur in significant out-of-pocket expenses, mostly due to gap payments, pharmaceutical costs, and travel costs such as transport, car parking, food, and accommodation. None of these necessary expenses are currently covered by Medicare.
“Burns injuries are quite intensive, very invasive and require a lot of follow up. While the expenses might be as simple as sterilised water and bandages, quite often there are additional expenses such as costs associated with travelling away from home,” Dr Ryder said in a press release.
Some of the families interviewed reported having to spend at least $700 every time they travelled for a medical follow up, to cover basic expenses like food, fuel, and parking. Another family reported needing five months to recover financially from the costs associated with their child’s treatment and follow ups.
“In terms of the depth and breadth of financial burden, this is something that is not fully appreciated. Issues like loss of employment capacity, loss of social and community interaction, impact on siblings and other extended family are all relevant issues. Extended family were mitigating factors to financial stress, where families often reported on extended family assisting with paying bills or purchasing necessities (i.e. formula),” Dr Ryder told Medical Forum.
The way forward
Another problem identified by this study involves communication. There are government-funded initiatives aimed at helping patients in need, like the Patient Assisted Travel Scheme. However, information about these programs not always reach families in need or the programs are not implemented effectively.
“Often eligible families were not informed and subsequently did not access government support initiatives. Other research in this area has reported on the difficulties and challenges that Aboriginal families face with access to these support initiatives,” Dr Ryder told Medical Forum.
“One family reported on having access to a social worker while in hospital for initial treatment, where fuel and food vouchers were provided which assisted the family, however this support ended on hospital discharge and was not followed through in follow up care.,” she added.
According to Dr Ryder a key aspect that needs improvement is ensuring that Aboriginal patients and their families are assigned some form of support, through Aboriginal Health/Liaison Officers, or social workers. The goal is to help families navigate the intricacies of the Australian health care system and finding relevant support programs. “Making government support initiatives easier accessible and supportive would be a starting point,” Dr Ryder said.