Out-of-pocket expenditure in childhood cancer during the COVID-19 pandemic in Peru





Covid-19 pandemic, Health insurance, out-of-pocket, universal coverage


Background: The COVID-19 pandemic has led to unprecedented economic and health vulnerability and inequities globally. Objective: This study examines the out-of-pocket expenses assumed by parents of children and adolescents with cancer in Peru during the COVID-19 pandemic and compares them to those corresponding to the pre-COVID era. Materials and methods: We conducted a cross-sectional survey of parents and caregivers of pediatric cancer patients who were cared for in public and private institutions between October and November 2020. All of them gave their consent before completing the survey. Respondent parents of children diagnosed before March 2020 were considered the pre-COVID-19 pandemic group, whereas if the definitive diagnosis was made after this date, it was classified as part of the COVID-19 group. Results: A total of 222 parents and caregivers of children with cancer responded to the survey. Almost half of the respondents lived in Lima. The average monthly family income was USD 388.4 and USD 314.7 before and during the COVID-19 pandemic. The average expenditure was USD 487.0 (SD, 453.5) and USD 415 (SD, 414.5) before and during the COVID-19 pandemic, before the cancer diagnosis. The average expenditure was USD 454.6 (SD, 406.7) and USD 387.5 (SD, 323.4) before and during the COVID-19 pandemic after a cancer diagnosis. In the COVID-19 group, the rate of catastrophic expenditure on these families was 86% before the definitive diagnosis and 75% after the cancer diagnosis. According to the type of cancer, families with a child diagnosed with a solid tumor had significantly higher out-of-pocket expenses than a leukemia than those with a child with leukemia prior to their diagnosis. Conclusion: Our study suggests that high out-of-pocket health expenses were frequent in families with a child with cancer in Peru during the COVID-19 pandemic. It is possible to infer that this situation was aggravated by the decrease in economic income of most families due to the disruption of formal and informal employment.


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