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Associate Professor of Sociology, University of Virginia 

Subsidizing Day-Care—The Medical Costs


Bryce J. Christensen and Nicole M. King


Government officials around the world recognize the direct budgetary cost of subsidizing the day care centers now caring for millions of young children whose mothers have left the home for employment. What they might not realize is how putting these children in day care centers is driving up medicals costs borne by both parents and governments. But two new studies—one from Denmark, one from South Korea—underscore the medical cost of the global displacement of at-home mothers by day care center employees.

Lauded by progressives around the world for its extensive system of day-care centers, Denmark now claims international prominence in a way it may not welcome: Doctors now surgically insert ventilation tubes in the ears of a higher proportion of young children in Denmark than they do in any other country on the planet. Such tubes are typically inserted only after children have repeatedly suffered from middle-ear infection (otitis media).  

Denmark’s unparalleled rate for the insertion of ventilation tubes was recently documented by a team of researchers affiliated with the University of Copenhagen and the Université Paris Descartes. After analyzing data for all Danish children who had ventilation tubes inserted in their ears between January 1, 1997 through December 31, 2011, the researchers concluded that “nationwide the prevalence of VT [Ventilation Tube Insertion] was 24% in children aged 0 to 3 years, with a significant increase over the study period.” In contrast, the researchers note, “in the United States [only] 6.8% of children have had VT before the age of 3.” The researchers indeed acknowledge that Denmark now has “the highest incidence [of such surgical insertions] recorded in the world.” Why does Denmark now stand out in this dubious way? The researchers identify a family history of middle-ear disease and the presence in the home of older siblings as predictors of ventilation-tube insertion. But they also acknowledge another significant cause, one raising questions about progressives’ enthusiasm for Danish reliance on non-maternal child care. The researchers report that “early start in daycare” was associated in their data with an increased likelihood of ventilation tube insertion (p = 0.0577), hardly an irrelevant association for this analysis given that “in Denmark, children are typically attending daycare centers within the first year of life.”

The researchers in fact interpret the linkage between day care and ventilation-tube insertions in Denmark in the light of a 2000 American study which likewise determined that “daycare attendance was a risk factor of VT.” The researchers also cite a 2014 meta-analysis of studies from around the world on risk factors for otitis media, a meta-analysis which concludes that “attending daycare increases the risk of otitis media.”

What the Danish scholars have established in their recent investigation of Denmark’s astounding number of children now requiring ventilation-tube insertions harmonizes all too well with the findings of a recent study in South Korea on “the prevalence and economic burden of OT [otitis media] in Korea.” In Seoul as in Copenhagen, researchers looking at children suffering the ill effects of middle-ear infections end up looking at—and asking hard questions about—day-care centers as a substitute for maternal care.

Affiliated with Kyung Hee University and CHA University School of Medicine, the authors of the new Korean study parsed data from national health insurance claims for 2012. These data indicate that for the year in question, 1,788,303 Korean patients received medical treatment for otitis media. The scholars calculate that the burden of treating all of these patients totaled $497 million U.S., mostly the direct cost of the medical care itself but partly “indirect costs” such as “work-loss costs.” By way of comparison, the researchers note a 2004 study concluding that “the annual economic burden of OM in the US is approximately 3–5 billion US dollars (USD), although the real cost may be higher, because of underestimated indirect costs.” Though the total cost of treating middle-ear infections may run considerably lower in Korea than in the United States, with its much larger population, the Korean researchers stress that the economic burden incident to middle-ear infection in their country is still “substantial”: “The economic burden of OM,” they point out, “accounted for more than half of the burden of breast cancer.” 

But in Korea as in Denmark or any other country, middle-ear infections mostly occur in children. Children under the age of nine years accounted for more than half (60%) of the patients identified in the Korean analysis and the for more than half (55%) of the total consequent cost.

The authors of the recent Danish study would understand an important reason that children account for most of the cost of treating middle-ear infections in Korea. The Korean researchers cite “a Korean study [that] revealed that children who were <9 years old accounted for >90% of cases that required myringotomy or v[entilation]-tube to treat A[cute]OM.”

And like their Danish colleagues, the authors of the Korean study interpret their findings in part by relying on previous research showing that “daycare attendance is a significant risk factor for A[cute]OM.”   

Because of the dominance of day-care-affirming progressive ideology in higher education, it must have taken some courage for the Korean scholars to wonder about “the Korean government . . . increas[ing] its funding of daycare centers, with approximately 77.3% of <5-year-old children attending a daycare center.” These scholars even have the temerity to call for “further research . . . to evaluate how promoting daycare may affect the prevalence and burden of OM.”

Middle-ear infections and the medical treatments required to treat them constitute but a small part of the harm inflicted by the global substitution of day care for maternal care. But asking straight questions about even that small part of the harm may start the overdue discussions—in Europe, in Asia, and around the globe—about just what burdens governments are placing on their people by promoting nonmaternal child care.

(Tine Marie Pedersen et al., “Incidence and Determinants of Ventilation Tubes in Denmark,” PLOS ONE 11.11 [2016]: e0165657, Web; Young-Eun Kim et al., “The Economic Burden of Otitis Media in Korea, 2012: A Nationally Representative Cross-Sectional Study,” Biomedical Research International [2016]: 3596261, Web.)