Abstract
INTRODUCTION: This study explores the economic burden and accessibility of healthcare services for families in Saudi Arabia managing Down syndrome (DS), emphasizing urban-rural disparities within the country's dual healthcare system. METHODS: A cross-sectional survey design was employed to collect primary data from 220 families (urban=128, rural=92) through self-administered questionnaires distributed between January and September 2024. Multiple regression analysis identified primary cost drivers, whereas service integration analysis assessed healthcare accessibility. RESULTS: The results indicated that the average monthly cost of Down syndrome care was SAR 4,200 (USD 1,120) for urban families and SAR 3,900 (USD 1,040) for rural families, consuming approximately 60% of the average household income. The key cost drivers included medical expenses (β = 0.800, p < 0.001, 95% CI [0.620, 0.980]) and daily care hours (β = 0.600, p < 0.001, 95% CI [0.460, 0.740]), whereas government support (β = -0.350, p < 0.001, 95% CI [-0.510, -0.190]) significantly reduced financial strain. Service integration analysis revealed significant urban-rural gaps, including disparities in therapy access (17% gap, p = 0.003) and educational support (19% gap, p = 0.001). Insurance coverage was significantly higher in urban areas (86%) than in rural regions (77%) (χ (2) = 6.43, p = 0.012), and transportation costs were proportionately higher for rural families (17% vs. 13% of the total costs, p = 0.008). DISCUSSION: These findings highlight substantial financial and service access challenges, underscoring the need for enhanced government support, improved rural healthcare infrastructure, and comprehensive insurance reform. This study advocates a centralized database to monitor healthcare costs and inform policy development aligned with the Vision 2030 objectives.