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照顾慢性病患儿的经济负担和时间负担的异质性。

The heterogeneity in financial and time burden of caregiving to children with chronic conditions.

作者信息

Zan Hua, Scharff Robert L

机构信息

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

出版信息

Matern Child Health J. 2015 Mar;19(3):615-25. doi: 10.1007/s10995-014-1547-3.

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.

摘要

我们研究了照顾慢性病患儿所带来的经济和时间负担,重点关注不同疾病类型之间的差异。利用2003年至2006年全国健康访谈调查以及2004年至2008年医疗支出面板调查的关联数据,我们创建了与14组儿童慢性病相关的经济负担(自付医疗费用、自付医疗费用与家庭收入的比率、保险支付的医疗费用以及总医疗费用)和时间负担(因病或受伤错过的上学时间以及就诊次数)指标。我们使用两部分模型评估疾病对经济负担的影响,并使用有限混合/潜在类别模型分析照顾的时间负担。在控制其他社会人口特征对照顾负担的影响后,慢性病患儿相对于健康儿童的照顾负担而言,面临着更高的经济和时间负担。经济负担水平以及家庭与保险系统之间的负担分担也因疾病类型而异。例如,患有广泛性发育障碍或心脏病的儿童对家庭来说经济负担相对较低,而对保险系统来说成本较高。相比之下,视力困难对家庭来说经济负担相对于其他人承担的成本较高。在时间负担方面,脑瘫和心脏病等疾病带来的时间负担较低,而广泛性发育障碍等疾病则与高时间负担相关。这项研究表明,不同类型慢性病患儿的照顾负担存在差异。每种疾病对家庭和保险系统来说都有独特的时间和经济成本负担情况。这些结果对政策制定者以及家庭的储蓄和就业决策具有启示意义。

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