Asset Building for Child Health: Pilot Test of Child Development Accounts (CDAs) for Children with Autism in China

Background and Objective: Epidemiological data suggest that autism spectrum disorder is the largest single category of developmental disabilities in China, with more than 2 million children affected among 14 million individuals with autism. These children have numerous special healthcare needs, including behavior and communication therapies and prevention of self-injurious behaviors. However, they face significant barriers in accessing healthcare due to the high cost of services. Healthcare for children with autism is a significant public health challenge in China and also affects families' financial well-being. To address this dual challenge, this study aims to (1) design an asset-building program through Child Development Accounts (CDAs) for children with autism and (2) design a data collection plan to assess the feasibility, fidelity, and effectiveness of the demonstration.

Methods: The study conducted a systematic review of CDA policy design examples from the United States, United Kingdom, Canada, Israel, Singapore, Korea, mainland China and Taiwan, Uganda, and other countries, and collected information from parents of children with autism to understand their asset-building needs. Furthermore, the study reached out to different financial institutions to understand their interest and product design. Based on the CDAs proposed by these financial institutions, the study further developed a data collection process and designed qualitative surveys based on previous CDA research.

Results: The study created CDAs for children with autism through commercial insurance accounts, which include three components: (1) annuity insurance to accumulate assets for health needs over the mid to long term; (2) universal life insurance for parents to provide assets for children after the death of parents; and (3) financial education to improve parents' financial capability. Accumulated assets in CDAs could later be turned into insurance-based disability trust funds. Funds in the insurance-based CDAs will come from family contributions and nonprofit donations, as well as investment earnings. The study will collect data from 1,000 participants in a baseline survey and a one-year follow-up survey, including information on parents' financial capability, financial well-being, assets accumulated for children, health expenditures and healthcare services, and mental health status. Currently, the project is in the process of collecting baseline data and has completed data collection for 60 participating families.

Conclusions and Implications: The CDA model explored in the study, if successful, has the potential to be implemented for millions of vulnerable children with disabilities in China to promote their wealth and health. Based on the CDA design, the policy can enable the accumulation of assets for health, economic independence, and long-term financial security of children with autism. The effects of the CDAs for children with autism should be further assessed for future policy improvement.