Predictors of rehabilitation needs, utilization patterns, and out-of-pocket costs among children with disabilities: evidence from a national survey

This study examined predictors of rehabilitation therapy needs, utilization time, and out-of-pocket (OOP) costs among children with disabilities in South Korea. We conducted a cross-sectional secondary analysis using data from the 2020 National Survey of the Disabled, including 338 children under 18 years of age. Rehabilitation needs, weekly therapy duration, and OOP costs were analyzed using descriptive statistics, chi-square tests, and logistic regression, with duration- and cost-related analyses restricted to the subsample of 250 children currently receiving therapy. Rehabilitation needs were significantly associated with brain lesions, speech disabilities, and receipt of housing benefits. Younger age, greater disability severity, higher household income, and stronger family support were related to longer weekly therapy duration. Average monthly OOP expenditures were 186 640 KRW, with higher costs linked to increased utilization, higher income, better home accessibility, and greater perceived discrimination, while lower satisfaction with welfare projects was associated with higher costs. Logistic regression identified brain lesions (OR 7.63), speech disabilities (OR 2.44), and housing benefit receipt (OR 3.28) as strong predictors of rehabilitation needs. Despite limitations in survey weighting and measurement, these findings highlight substantial socioeconomic and disability-related disparities in rehabilitation access and financial burden. Policy efforts are needed to reduce inequities, strengthen family-centered multidisciplinary rehabilitation services, and expand equitable access for children with disabilities and their families.