Children with disabilities frequently have unmet health care needs.1,2 Several studies have examined health care utilization by children with disabilities.3, 4, 5 However, the influence of parental disability on health care utilization by children with disabilities has not been adequately explored.

Family aggregation of disability is not uncommon.6,7 For example, in the United States, having multiple disabled members within a family is common.8 Hearing, visual, and intellectual disabilities may be due to generic factors and thus can cluster within families.7,9,10 Thus, households with children who have disabilities often include other members with disabilities.11 These households typically have considerably fewer resources than those without members with disabilities.11

Managing children with disabilities can be challenging for parents. For instance, children with disabilities and their families may experience stigma or social exclusion,12 and this challenge can be substantially greater for parents who have disabilities themselves. However, studies have not focused on the healthcare utilization patterns of children with disabilities of parents with disabilities, a group that may underutilize the resources available to them under universal health coverage (UHC) systems, where financial barriers are reduced. Countries without UHC systems are highly unlikely to fulfill healthcare needs of children with disabilities because medical costs can create additional barriers to healthcare access.

Parents with disabilities face several challenges. In the United States, a study revealed that individuals with disabilities tend to experience major disparities in multiple aspects of life, including employment, income, and participation in safety net programs.13 Parents with intellectual disabilities are particularly more likely to have poor birth outcomes and self-reported poor health and depression.14 Individuals with disabilities typically face certain limitations when attempting to access health care after the onset of disability,15 and they experience substantial health disparities and have poorer health outcomes compared with those without disabilities.16

Parents with disability often experience considerable financial challenges. In the United States, individuals with disability are less likely to be covered by private health insurance.17 Individuals with disability are more likely to have unmet healthcare needs due to costs.18 In countries without UHC, such as the United States, out-of-pocket expenses can be substantially higher for children with special healthcare needs,19 creating financial difficulties for lower-income households where both parents and children have disabilities.

Other than financial barriers, children with disabilities who also have parents with disabilities may face additional challenges in accessing health care for several reasons. First, parents with disabilities fulfill dual roles as care recipients and caregivers.20,21 These dual roles require additional resources to fulfill, including time. Second, parents with disabilities face considerable challenges in daily childcare due to the physical and cognitive demands involved.22,23 Third, individuals with disabilities often encounter social discrimination.24,25 These negative attitudes can extend even to physicians.26,27 Discrimination in health care heightens caregiving burdens and can lead to a decline in parental well-being.28 Additionally, parents of children with disabilities experience difficulty navigating the healthcare system, especially when services are fragmented across or within providers.29,30 In the qualitative study of Herrera et al. (2024), parents with disability reported that healthcare staff focused more on their disabilities than on their children's needs.31 These factors can exacerbate the challenges faced by parents with disabilities seeking to provide health care for their children with disabilities.

A UHC system that ensures essential healthcare access for all without financial hardship can potentially increase health care utilization for people with disabilities. The literature review indicates that, in addition to financial difficulties, individuals with disabilities can experience numerous challenges when seeking health care. Thus, it is likely that children with disabilities who have parents with disabilities may experience underutilization of healthcare services, even in countries like Taiwan with UHC healthcare systems. Furthermore, this underutilization tends to increase in relation to gaps in general access to healthcare coverage. .

To our knowledge, no studies have examined whether, or to what extent, children with disabilities who have parents with disabilities face disparities in health care utilization.

Taiwan implemented its National Health Insurance (NHI) system in 1995. Enrollment in the NHI program in Taiwan is mandatory for all citizens and covers approximately 24 million individuals. The NHI system provides a comprehensive range ofhealthcare services, including hospitalization, outpatient services, emergency care, various medical procedures (such as surgery), diagnostics, and dental care (such as regular cleanings and evaluations, root canal treatments, and treatment for tooth decay, and dental diseases). Approximately 92 % of healthcare facilities, including clinics and hospitals, participate in the NHI program.32 The healthcare organizations in Taiwan are categorized into 4 levels: clinics, district hospitals, regional hospitals, and medical centers. Patients can choose freely among the 4 tiers without a referral. However, the copayment increases with higher-tier healthcare organizations without a referral. For individuals holding a disability certification, regardless of the level, the copayment fee for outpatient visits is set at NT$50 (approximately US$1.67). Individuals with disabilities are also partially exempted from copayment for emergency care and drug copayments.33

In Taiwan, despite universal access to the NHI system, health care may nevertheless present financial burdens due to copayments and noncovered pharmaceuticals. Additionally, parents with disabilities may be compelled to explore alternative care options, such as buying over-the-counter medications, due to the nonfinancial barriers they encounter.

The purpose of this study was to determine whether children with disabilities with at least one disabled parent can access health care to the same extent as disabled children whose parents are not disabled under Taiwan's UHC system. We hypothesized that disabled children who also have disabled parents would lack access to health care compared with disabled children without disabled parents. Another goal of this study was to determine whether the effect of parental disability on health care utilization varies with child's age. We did not propose a hypothesis for this goal because of its exploratory nature.