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The Heterogeneity in Financial and Time Burden of Caregiving to Children with Chronic Conditions

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Abstract

We examine the financial and time burdens associated with caring for children with chronic conditions, focusing on disparities across types of conditions. Using linked data from the 2003 to 2006 National Health Interview Survey and 2004–2008 Medical Expenditure Panel Survey, we created measures of financial burden (out-of-pocket healthcare costs, the ratio of out-of-pocket healthcare costs to family income, healthcare costs paid by insurance, and total healthcare costs) and time burden (missed school time due to illness or injury and the number of doctor visits) associated with 14 groups of children’s chronic conditions. We used the two-part model to assess the effect of condition on financial burden and finite mixture/latent class model to analyze the time burden of caregiving. Controlling for the influences of other socio-demographic characteristics on caregiving burden, children with chronic conditions have higher financial and time burdens relative to caregiving burdens for healthy children. Levels of financial burden and burden sharing between families and insurance system also vary by type of condition. For example, children with pervasive developmental disorder or heart disease have a relatively low financial burden for families, while imposing a high cost on the insurance system. In contrast, vision difficulties are associated with a high financial burden for families relative to the costs borne by others. With respect to time burden, conditions such as cerebral palsy and heart disease impose a low time burden, while conditions such as pervasive developmental disorder are associated with a high time burden. This study demonstrates that differences exist in caregiving burden for children by type of chronic condition. Each condition has a unique profile of time and financial cost burden for families and the insurance system. These results have implications for policymakers and for families’ savings and employment decisions.

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Notes

  1. Because labor market decisions are affected by the financial and time burden of caregiving and we decide not to discuss about labor market costs in this paper.

  2. We use the cost measures in the first year of each MEPS panel. .

  3. Total health care costs refer to the direct healthcare costs spent on a child. We are not able to include other costs such as transportation costs to healthcare facilities due to data limitations. We also omit indirect costs such as labor-market consequences of caregiving on caregivers because the labor market costs are affected by the financial and time burden of caregiving.

  4. MEPS asks the number of days that a person missed a half day or more of school (or day care) because of a physical illness or injury, or a mental or emotional problem including the time the person was in the hospital (See relevant questions in the Disability Days Section at http://meps.ahrq.gov/survey_comp/hc_survey/2008/DD1201.pdf). Therefore, the measure of missed school days can have the value of 0.5 (a half day) in addition to integers. In order to model count data with only integers, we examine the number of half days.

  5. We added up the use of different healthcare services including office-based provider visits, office-based physician visits, office-based non-physician visits, office-based chiropractor visits, office-based nurse/practitioner visits, office-based optometrist visits, office-based physician assist visits, office-based physical therapist/occupational therapist visits, outpatient department provider visits, outpatient department physician visits, outpatient department non-doctor visits, chiropractor visits (office-based + outpatient), ambulance nurse/practitioner visits (office-based +outpatient), ambulance optometrist visits (office-based + outpatient), physician assist visits (office-based + outpatient), ambulance physical therapist/occupational therapist visits (office-based + outpatient), and emergency room visits.

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  1. Hua Zan

    Present address: Center on the Family, University of Hawaii at Manoa, 2515 Campus Road, Miller Hall 103, Honolulu, HI, 96822, USA

Authors and Affiliations

  1. University of Missouri, Columbia, MO, USA

    Hua Zan

  2. Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA

    Robert L. Scharff

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Correspondence to Hua Zan.

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Zan, H., Scharff, R.L. The Heterogeneity in Financial and Time Burden of Caregiving to Children with Chronic Conditions. Matern Child Health J 19, 615–625 (2015). https://doi.org/10.1007/s10995-014-1547-3

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