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€ (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€ (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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The ethical approval for the use of this dataset has been obtained from the Ethics Committee of the Finnish Institute for Health and Welfare, THL (572/2013). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes