Burden of pediatric diarrhea: Perceptions of cost among Bolivian caregivers

Bolivia has high rates of diarrhea-related child morbidity and mortality. Bolivian caregivers benefit from universal insurance for their children and are believed to have minimal diarrhea-related expenses. The study goal was to characterize caregiver costs and cost perceptions associated with treatment for pediatric gastroenteritis in Bolivia. From 2007 to 2009, researchers interviewed 1101 caregivers of pediatric patients (<5 years of age) seeking treatment for diarrheal illness in seven healthcare settings in Bolivia. Caregivers were surveyed on demographics, clinical symptoms, direct (e.g. medication, consult fees) and indirect (e.g. lost wages) costs, and perceived economic burden of the child's illness. Patient populations were similar across hospitals in terms of gender; age, duration of illness, and income varied by appointment type. Direct and total costs to families were significantly higher for inpatients compared to outpatients (p < 0.01). Overall, 74% of caregivers reported that the treatment cost affected their family economy. Logistic regression indicated significant positive associations of cost perception with cost burden (cost incurred as a percentage of annual income; OR 20.83 95% CI [4.39 - 98.98]) and appointment type (outpatient vs. inpatient, OR 2.06, 95% CI [1.22 -3.49]). Diarrhea-related costs were a large burden on Bolivian families. Those with a high cost burden were most likely to perceive these costs as posing economic hardship, and perceptions of cost were higher among caregivers of outpatients compared to inpatients. Families who perceive outpatient treatment as costly may delay care, potentially resulting in the need for more expensive inpatient care.