Impact of disability-based discrimination in healthcare on parents of children with medical complexity

Needs beyond coverage: Health care inequities among children with disabilities of parents with disabilities

BACKGROUND

Family aggregation of disability is not uncommon. Research on children with disabilities has often overlooked a specific group facing health disparities: children with disabilities of parents with disabilities.

OBJECTIVE

To determine whether children with disabilities, whose parents also have disabilities, experience limited access to health care.

METHODS

This is a dynamic cohort study. The data used in this study were the 2017-2021 Taiwan's National Disability Registry and the National Health Insurance claims data. All children were matched to their biological fathers and mothers using a unique anonymous identification number to identify the disability status of the children and their parents and the receipt of health care services by the children.

RESULTS

In 2021, a total of 2 834 870 pairs of children and parents were identified, of whom 53,419 were children with disabilities. Of these, 5188 had at least one parent with disabilities. Compared with children whose parents did not have disabilities, those whose parents both had disabilities had 1.71 fewer outpatient visits per year (P = .013). Compared with children whose parents had no disabilities, those whose parents had disabilities had 5.0 and 4.2 fewer general outpatient visits at birth (P < .001) and at the age of 2 years (P < .001), respectively. The magnitude of this effect decreased as the children's age increased.

CONCLUSIONS

Children with disabilities whose parents also have disabilities may underutilize health care even in settings such as Taiwan, where universal health coverage is available. Standard health programs do not eliminate health care utilization disparities for such children.

Experiences and factors affecting poverty among families raising a child with a disability: a scoping review

PURPOSE

Children with disabilities and their families are more likely to live in poverty than those without a disability. However, little is known about their lived experiences and the circumstances that influence their socio-economic condition. The aim of this study was to understand the experiences and factors affecting poverty among families raising children with disabilities.

METHODS

A scoping review was conducted while searching eight international databases (Embase, Healthstar, Medline, PsycINFO, Econlit, Scopus, Web of Science, and Sociological Abstracts). About 2351 articles were independently screened, and 48 studies met the inclusion criteria.

RESULTS

The 48 studies included in the review involved 18 countries over a 26-year period. Our findings highlight the following key trends: (1) rates and extent of poverty, (2) types of poverty (i.e., material hardship, cost burdens, food insecurity), and (3) factors affecting poverty among children and youth with disabilities and their families (i.e., type and severity of disability, age, race/ethnicity, single-parent households, employment status, education, financial supports, type of health insurance, and community and societal factors).

CONCLUSIONS

There is an urgent need for anti-poverty policies, interventions and resources to help support families raising a child with a disability.

Ableism's pervasive impact in healthcare: A time for action

This commentary is on the original article by Ames et al. on pages 1226–1233 of this issue.