Evaluation of the Rinkeby extended home visiting program using a natural experiment following a governmental stimulation package for accessible child health services

The Swedish government pledged to close the health equity gap in a generation, underlining the compensatory task of child health services.

To stimulate the delivery of more accessible child health services the government distributed 120 MSEK annually 2018-2020 to the 21 regions.

These had autonomy to decide what measures to introduce, but an extended home visiting program, the Rinkeby-model, was especially promoted.

The Rinkeby-model is a well-defined intervention for low SES areas, including oral care, health promotion, injury prevention, father involvement, and guidance on adequate use of health services.

However, there has been no large-scale evaluation of the program.The purpose is to evaluate the effect and cost-effectiveness of the Rinkeby-model in Sweden by making use of the “natural experiment” that occurred when regions autonomously decided how to use the stimulation package.

The method proposed is a matched difference-in-differences approach utilizing changes over time to estimate the impact of the Rinkeby-model on health outcomes (n=41 child health centres, [CHC] in 5 regions), compared to certain enhanced services for low SES groups (n=31 CHCs in 11 regions) or enhanced resources in low SES areas (n=12 CHCs in 5 regions); N~63 000 children.

Personal identifiers of children listed at CHCs will be acquired from the regions and used to create a Care Needs Index for all CHCs.

Children’s personal identifiers will then be linked to register data for: dental caries, emergency room visits, hospitalization, prescription drug use, preschool attendance, parental leave and sick days. For some regions we have data on passive smoking, breastfeeding and vaccinations.

The health care and societal costs of measured outcomes will be assessed in a cost-benefit analysis.By using registry data, estimating costs, and involving decision-makers as users, this study will indicate whether the Rinkeby-model is a (cost-) effective compensatory intervention in child health services.