03565nas a2200361   4500000000100000008004100001260001600042653002400058653003300082653005700115653003000172653001800202653004600220653005400266653002900320653002200349653002200371100001100393700000900404700001100413700001000424700001000434700001100444700001200455700000900467700001200476245020600488856007500694300000900769490000700778520240400785022001403189       2023                            d  bElsevier BV10aInfectious Diseases10aPsychiatry and Mental health10aPublic Health, Environmental and Occupational Health10aObstetrics and Gynecology10aHealth Policy10aPediatrics, Perinatology and Child Health10aChildren and adolescents living with disabilities10a Rehabilitation services10aMedical Treatment10aschool attendance1 aWang H1 aLi Z1 aChen S1 aQin W1 aXie L1 aKong Y1 aCohen J1 aLu C1 aLiang W00aThe effect of a disability-targeted cash transfer program on universal health coverage and universal access to education: a nationwide cohort study of Chinese children and adolescents with disabilities  uhttps://www.thelancet.com/action/showPdf?pii=S2666-6065%2822%2900250-4  a1-120 v313 a<p><strong>Background:&nbsp;</strong>To achieve improved outcomes for children and adolescents with disabilities, it is central to have universal health coverage (UHC) and universal access to education. This study investigates whether a disability-targeted cash transfer (CT) program is associated with improved access to healthcare and education for children and adolescents with disabilities.</p>

<p><strong>Methods:&nbsp;</strong>We used nationwide survey data of two million children and adolescents living with disabilities, who aged 8–15 years when entering the cohort between January 1, 2015, and December 31, 2019. With a quasi-experimental study design, we compared the outcomes between CT beneficiaries who newly received CT benefits during the study period and non-beneficiaries who were disabled but never received CT using logistic regressions after propensity score matching with a 1:1 ratio. Outcomes of interest were utilization of rehabilitation services in the past year, medical treatment if the individual had illness in the past two weeks, school attendance if not in school at the start of the study, and reported financial hardship to access these services.</p>

<p><strong>Findings:&nbsp;</strong>Of the total cohort, 368,595 children and adolescents fit the inclusion criteria, including 157,707 new CT beneficiaries and 210,888 non-beneficiaries. After matching, CT beneficiaries showed 2.27 (95% confidence interval [CI]: 2.23, 2.31) higher odds of utilizing rehabilitation services and 1.34 (95% CI: 1.23, 1.46) higher odds of getting medical treatment compared to non-beneficiaries. CT benefits were also significantly associated with less report of financial barrier to access rehabilitation services (odds ratio [OR]: 0.63, 95% CI: 0.60, 0.66) and medical treatment (OR: 0.66, 95% CI: 0.57, 0.78). Moreover, CT program was associated with higher odds of school attendance (OR: 1.99, 95% CI: 1.85, 2.15) and lower odds of reporting financial difficult to access education (OR: 0.41, 95% CI: 0.36, 0.47).</p>

<p><strong>Interpretation:&nbsp;</strong>Our results suggest that the receipt of CT was associated with improved access to health and educational resources. This finding provides supporting evidence for the identification of efficient and feasible interventions to move toward UHC and universal education under the Sustainable Development Goals.</p>
  a2666-6065