The effects of economic difficulties on social and health care costs of children: target trial emulation using complete birth cohort data in Finland

It is unclear how much costs economic difficulties incur to the health and social care sector, which is a critical research gap to support the economic case for preventing child poverty. We examine the health and social service costs due to families entering into, and transitioning out of, social assistance used as a proxy measure for economic difficulties. We analyzed register data on all Finnish children born in 1997 in the framework of a non-randomized target trial. Inverse probability treatment weighting techniques were used to make the comparison group similar to the treatment group in terms of 29 pretreatment variables. Entry to social assistance was associated with some 1398-2591{euro} (50%) higher cumulative health and social care costs of the children three years after their families transitioned to social assistance, compared to the group that did not enter to social assistance system. This difference was primarily attributed to higher social care costs. Continued social assistance use was associated with some 1018-2775{euro} (31%) higher costs compared to the comparison group that exited social assistance. These findings support an economic argument to prevent families from entering economic difficulties and to help those in such situations to transition out.