Household financial burden of families having children with cerebral palsy: evidence from Vietnam

Abstract

Research Motivation: Persons with disabilities face barriers in all aspects of the health system. Cerebral palsy (CP) is the most common childhood physical disability with complex medical needs. It is critical for each child with CP to receive the medical treatments, recurrent rehabilitation, and education services from different healthcare professionals. This leads to increased healthcare costs and reduced productivity of at least the main caregiver. Having evidence on the financial burden of a household with children under 6 years old with CP in Vietnam is essential for getting specific funding in addition to the social health insurance program. Methods: The financial burden of household of children with CP in this current study includes out-of-pocket payment, indirect costs and loans. Indirect costs were measured by self-reporting from the main caregivers on the income lost each month due to daily taking-care of the child or due to health incidences related to CP. Average expenditure and utilization rates for different services from this sample were obtained to estimate the out-of-pocket payment. Loans included borrowing money and take out loans. 78 main caregivers of children with CP under 6 years old across Vietnam were interviewed by Google form shared on the social media channels of the Cerebral Palsy Family Association of Vietnam, after getting explanations. Results: More than half (57.69%) lived with Gross Motor Function Classification System (GMFCS) level 5. Each child, on average, lives with about 5 different comorbidities, and 74% of the sample had epilepsy. The OOP Payments contributed 92.46% of total healthcare expenditure, which is nearly double of the national indicator (42.95%), higher than WHO’s recommended threshold of 30%-40%. Families tend to use more private healthcare services, creating an average OOP Payments in the private group that is about 6 times that of the home-based group and about 7 times of the state facilities group. Families in major cities lost about 33% of their total income due to productivity lost, 22.6% for families in other locations. The mean loan of families living outside Ho Chi Minh city and Ha Noi was more than 2 times of one of families living in these 2 cities. Every 1% increase in OOP Payments per year results in a 0.55% increase in the total loan amount (Standardized Beta coefficient = 0.55). Conclusions: Families of children with CP faced dual challenges of excessive OOP Payments and income loss. The more OOP costs it was, the more loans that the families got. Through this observation, it is suggested that specific insurance packages should be offered to the population. Moreover, state support policies are advised to conduct more profound interference to provide families with loans similar to Corporate Society Responsibility programs or more appropriate financial adjustments of philanthropic organizations. In medical aspects, community-based rehabilitation (CBR) programs should be improved so that families will not need to leave their homeland for major cities due to their children’s treatment and therapy and simultaneously lose their employment.