The impact of child maltreatment intervention on healthcare underutilization in at-risk young children: A quasi-experimental study in Taiwan

Children from households at risk for maltreatment likely underutilize appropriate healthcare services, leading to unfavorable outcomes. Several programs have been implemented to reduce maltreatment, yet much less is known about whether such interventions may affect healthcare utilization in early childhood when unaddressed needs can exacerbate long-term health disparities. Based on administrative-linked data on child welfare and healthcare in Taiwan, this study examines whether targeted maltreatment prevention affects healthcare utilization among at-risk young children and investigates subgroup heterogeneity. We identified a cohort of 7,136 children aged 1–5 years old who received the High-Risk Family (HRF) program during 2012–2017; for comparison, 55,292 non-HRF children were sampled through the weighted propensity scores fine stratification approach. The weighted generalized linear models were used to estimate potential intervention-related differences in healthcare utilization. For at-risk young children, the average number of visits to outpatient care and the emergency room in the year before the HRF intervention was 17.1 and 0.91, respectively, compared to 20.4 and 0.70 in their non-HRF peers. The intervention-related differences in healthcare utilization were significantly manifested in outpatient care (adjusted β_wt, year 1 = 1.14, 95 % confidence interval [CI]: 0.74, 1.54; β_wt, year 2 = 1.94, 95 % CI: 1.48, 2.41). The observed increase in outpatient care utilization, which persisted for up to two years from the start, was especially prominent among preschoolers and near-poverty households. Our analyses indicated that maltreatment intervention-related beneficial effects on improving healthcare utilization among at-risk young children. Child protective services should collaborate and coordinate with medical providers at the system level to early identify and intervene in unfavorable health outcomes.