Healthcare-Related Financial Burden among Families in the U.S.: The Role of Childhood Activity Limitations and Income

Abstract

This study examined the impact of childhood activity limitations on family financial burden in the U.S. We used ten complete panels (1996-2006) of the Medical Expenditure Panel Survey (MEPS) to evaluate the burden of out-of-pocket healthcare expenditures for 17,857 families with children aged 0-17 years. Multivariate generalized linear models were used to examine the relationship between childhood activity limitation status and both absolute and relative financial burden. Families of children with limitations had higher absolute out-of-pocket healthcare expenditures than families of children without limitations ($594.36 higher; p<0.05), and were 54% more likely to experience relative burden (p<0.05). Substantial socioeconomic disparities in financial burden were observed. Policies are needed to enable these families to access appropriate and affordable healthcare services.

Figure 1

Figure 1A – Child-Level Absolute Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1A depicts the disparities in absolute financial burden for the child as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the mean change in absolute burden in 2006 dollars. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1B – Other Family Members Absolute Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1B depicts the disparities in absolute financial burden for other family members as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the mean change in absolute burden in 2006 dollars. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1C – Whole Family Absolute Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1C depicts the disparities in absolute financial burden for the whole family as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the mean change in absolute burden in 2006 dollars. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1D – Child-Level Relative Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1D depicts the disparities in relative financial burden for the child as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the ratio of the mean change in relative burden presented on a log scale. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1E – Other Family Members Relative Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1E depicts the disparities in relative financial burden for other family members as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the ratio of the mean change in relative burden presented on a log scale. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1F – Whole Family Relative Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1F depicts the disparities in relative financial burden for the whole family as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the ratio of the mean change in relative burden presented on a log scale. The red line indicates children with activity limitations and the blue line represents children without activity limitations.

Figure 1

Figure 1A – Child-Level Absolute Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1A depicts the disparities in absolute financial burden for the child as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the mean change in absolute burden in 2006 dollars. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1B – Other Family Members Absolute Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1B depicts the disparities in absolute financial burden for other family members as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the mean change in absolute burden in 2006 dollars. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1C – Whole Family Absolute Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1C depicts the disparities in absolute financial burden for the whole family as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the mean change in absolute burden in 2006 dollars. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1D – Child-Level Relative Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1D depicts the disparities in relative financial burden for the child as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the ratio of the mean change in relative burden presented on a log scale. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1E – Other Family Members Relative Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1E depicts the disparities in relative financial burden for other family members as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the ratio of the mean change in relative burden presented on a log scale. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1F – Whole Family Relative Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1F depicts the disparities in relative financial burden for the whole family as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the ratio of the mean change in relative burden presented on a log scale. The red line indicates children with activity limitations and the blue line represents children without activity limitations.

Figure 1

Figure 1A – Child-Level Absolute Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1A depicts the disparities in absolute financial burden for the child as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the mean change in absolute burden in 2006 dollars. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1B – Other Family Members Absolute Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1B depicts the disparities in absolute financial burden for other family members as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the mean change in absolute burden in 2006 dollars. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1C – Whole Family Absolute Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1C depicts the disparities in absolute financial burden for the whole family as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the mean change in absolute burden in 2006 dollars. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1D – Child-Level Relative Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1D depicts the disparities in relative financial burden for the child as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the ratio of the mean change in relative burden presented on a log scale. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1E – Other Family Members Relative Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1E depicts the disparities in relative financial burden for other family members as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the ratio of the mean change in relative burden presented on a log scale. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1F – Whole Family Relative Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1F depicts the disparities in relative financial burden for the whole family as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the ratio of the mean change in relative burden presented on a log scale. The red line indicates children with activity limitations and the blue line represents children without activity limitations.

Figure 1

Figure 1A – Child-Level Absolute Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1A depicts the disparities in absolute financial burden for the child as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the mean change in absolute burden in 2006 dollars. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1B – Other Family Members Absolute Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1B depicts the disparities in absolute financial burden for other family members as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the mean change in absolute burden in 2006 dollars. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1C – Whole Family Absolute Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1C depicts the disparities in absolute financial burden for the whole family as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the mean change in absolute burden in 2006 dollars. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1D – Child-Level Relative Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1D depicts the disparities in relative financial burden for the child as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the ratio of the mean change in relative burden presented on a log scale. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1E – Other Family Members Relative Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1E depicts the disparities in relative financial burden for other family members as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the ratio of the mean change in relative burden presented on a log scale. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1F – Whole Family Relative Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1F depicts the disparities in relative financial burden for the whole family as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the ratio of the mean change in relative burden presented on a log scale. The red line indicates children with activity limitations and the blue line represents children without activity limitations.

Figure 1

Figure 1A – Child-Level Absolute Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1A depicts the disparities in absolute financial burden for the child as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the mean change in absolute burden in 2006 dollars. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1B – Other Family Members Absolute Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1B depicts the disparities in absolute financial burden for other family members as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the mean change in absolute burden in 2006 dollars. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1C – Whole Family Absolute Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1C depicts the disparities in absolute financial burden for the whole family as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the mean change in absolute burden in 2006 dollars. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1D – Child-Level Relative Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1D depicts the disparities in relative financial burden for the child as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the ratio of the mean change in relative burden presented on a log scale. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1E – Other Family Members Relative Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1E depicts the disparities in relative financial burden for other family members as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the ratio of the mean change in relative burden presented on a log scale. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1F – Whole Family Relative Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1F depicts the disparities in relative financial burden for the whole family as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the ratio of the mean change in relative burden presented on a log scale. The red line indicates children with activity limitations and the blue line represents children without activity limitations.

Figure 1

Figure 1A – Child-Level Absolute Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1A depicts the disparities in absolute financial burden for the child as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the mean change in absolute burden in 2006 dollars. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1B – Other Family Members Absolute Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1B depicts the disparities in absolute financial burden for other family members as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the mean change in absolute burden in 2006 dollars. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1C – Whole Family Absolute Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1C depicts the disparities in absolute financial burden for the whole family as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the mean change in absolute burden in 2006 dollars. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1D – Child-Level Relative Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1D depicts the disparities in relative financial burden for the child as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the ratio of the mean change in relative burden presented on a log scale. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1E – Other Family Members Relative Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1E depicts the disparities in relative financial burden for other family members as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the ratio of the mean change in relative burden presented on a log scale. The red line indicates children with activity limitations and the blue line represents children without activity limitations. Figure 1F – Whole Family Relative Financial Burden in the US, by Childhood Activity Limitation Status and Income Figure 1F depicts the disparities in relative financial burden for the whole family as a function of family OECD-adjusted income. The reference point (gray line) is centered at the burden for families of children without an activity limitation with a mean income of $32,000. The y axis represents the ratio of the mean change in relative burden presented on a log scale. The red line indicates children with activity limitations and the blue line represents children without activity limitations.