About the Review
Published in The European Journal of Health Economics in 2025, the review was funded by the International Labour Organization, the UK’s Foreign, Commonwealth & Development Office, and the Arts & Humanities Research Council.
Standard poverty lines assume a person with a disability needs the same income as anyone else to reach the same standard of living. New research on disability extra costs and poverty, co-authored by Daniel Mont and Monica Pinilla-Roncancio of the Center for Inclusive Policy (CIP) and colleagues, shows that assumption is wrong, and that getting it wrong hides real poverty from view.
What Are Disability-Related Direct Costs?
They’re the extra, out-of-pocket expenses people with disabilities and their households pay to reach the same level of participation as everyone else, things like personal assistance, assistive devices, extra healthcare, and transportation. These costs sit on top of the “indirect” costs of lost income or education, and standard poverty measures routinely miss them.
How Much Do People with Disabilities Actually Pay?
The review pulled together 75 studies across 67 countries. Depending on the country and disability type, extra annual costs ranged from a few hundred dollars to tens of thousands, in some cases representing over 100% of household income. In eight of the 20 countries where researchers could measure the poverty impact, accounting for these costs more than doubled the poverty rate among disability households.
Why Do Estimates Vary So Much?
How Do Researchers Measure These Costs?
Four main methods are in use, and they don’t agree with each other. Some simply track what people actually spend, others compare spending between households with and without members with disabilities, some estimate the income needed to match a comparable standard of living, and one newer method tries to price out everything a person would need, whether they can currently afford it or not.
Which Method Gets Closest to the Truth?
The newest method, pricing required goods and services directly, consistently produced the highest estimates, because it’s the only one that captures unmet needs rather than just current spending. But it’s also the rarest: only six of the 75 studies used it, and all were in high-income countries.
Do These Costs Push People into Poverty?
Yes, and often sharply. The review found that health-related expenses alone could eat up more than 30% of household income in some low- and middle-income settings, with transportation and personal care close behind.
Can Social Protection Close the Gap?
Not on its own. Across multiple countries, disability cash transfers covered only a fraction of actual extra costs, in the UK, under 15%. Health insurance helped where it existed, but coverage gaps for rehabilitation, specialists, and assistive devices left many costs uncovered regardless.
What Should Policymakers Do Next?
The authors call for combining flexible social protection with investment in accessible health, education, and transport systems, since fixed cash payments alone can’t absorb costs that spike unpredictably. They also flag a need for more consistent methodology, so that estimates from different countries can actually be compared.
