Out-of-Pocket Costs for Childhood Stroke: The Impact of Chronic Illness on Parents' Pocketbooks

Abstract

Objective Direct costs for children who had stroke are similar to those for adults. There is no information regarding the out-of-pocket costs families encounter. We described the out-of-pocket costs families encountered in the first year after a child’s ischemic stroke. Methods 22 subjects were prospectively recruited at four centers in the US and Canada in 2008 and 2009 as part of the “Validation of the Pediatric NIH Stroke Scale” study; families’ indirect costs were tracked for one year. Every three months, parents reported hours they did not work, non-reimbursed costs for medical visits or other health care, and mileage. They provided estimates of annual income. We calculated total out-of-pocket costs in US dollars and reported costs as a proportion of annual income. Results Total median out-of-pocket cost for the year following an ischemic stroke was $4354 (range 0–$28,666; interquartile range $1,008–$8,245). Out-of-pocket costs were greatest in the first three months after the incident stroke, with the largest proportion due to lost wages, followed by transportation and non-reimbursed healthcare. For the entire year median costs represented 6.8% (range 0–81.9%; interquartile range 2.7–17.2%) of annual income. Conclusions Out-of-pocket expenses are significant following a child’s ischemic stroke. The median costs are noteworthy given that the median American household had cash savings of $3,860 at the time of the study. These results with previous reports of direct costs give a more complete view of the overall costs to families and society. Childhood stroke creates an under-recognized cost to society because of decreased parental productivity.

Survey of financial burden of families in the U.S. with children using home mechanical ventilation

“…A questionnaire was developed based on what has been included in previous studies of direct non‐medical and indirect costs of caring for children with chronic conditions and what is known about caring for children using HMV at home. Closed‐ended questions addressed the following areas: The demographic characteristics of the participants and their households, including the household's gross annual income and other caregivers of the child (paid and unpaid). The children's characteristics, including age, underlying condition, modality and frequency of use of HMV, and insurance coverage.…”

“…A questionnaire was developed based on what has been included in previous studies of direct non-medical and indirect costs of caring for children with chronic conditions 5,[8][9][10][11][12] and what is known about caring for children using HMV at home. Closed-ended questions addressed the following areas:…”

Gamified In-Home Rehabilitation for Stroke Survivors: Analytical Review

“…The objective of in-home rehabilitation gamified systems is to overcome the disadvantages of faceto-face therapy. As stated previously, one of the main problems is related to the economic viability compared to traditional in-hospital therapy [12,21,23,[56][57][58]. In order to be adopted in-home rehabilitation systems must be a low-cost solutions.…”

Childhood Stroke: Awareness, Interest, and Knowledge Among the Pediatric Community

“…Consequences of a stroke, including the impairment of hand-use, mobility, and behavioral or academic performance hinder development crucial for independent living, participation in everyday life, and quality of life in a significant number of patients ( 2 ). Subsequently, a substantial economic burden results on the health care system as well as for the families ( 3 , 4 ). Best clinical outcomes after a childhood stroke are only possible with rapid access to adequate neuroprotective intensive care, as well as to hyperacute management strategies proven effective in adults ( 5 , 6 ).…”