Financial toxicity experienced by rural Australian families with chronic kidney disease

Abstract

Aim: Chronic kidney disease (CKD) and its treatment places a financial burden on healthcare systems and households worldwide, yet little is known of its financial impact, on those who reside in rural settings. We aimed to quantify the financial impacts and out-of-pocket expenditure experienced by adult rural patients with CKD in Australia.Methods: A web based structured survey was completed between November 2020 and January 2021. English speaking participants over 18 years of age, diagnosed with CKD stages 3-5, those receiving dialysis or with a kidney transplant, who lived in a rural location in Australia.Results: In total 77 (69% completion rate) participated. The mean out of pocket expenses were 5056 AUD annually (excluding private health insurance costs), 78% of households experienced financial hardship with 54% classified as experiencing financial catastrophe (out-of-pocket expenditure greater than 10% of household income).Mean distances to access health services for all rural and remote classifications was greater than 50 kilometres for specialist nephrology services and greater than 300 kilometres for transplanting centres. Relocation for a period greater than 3 months to access care was experienced by 24% of participants. Conclusion:Rural households experience considerable financial hardship due to outof-pocket costs in accessing treatment for CKD and other health-related care, raising concerns about equity in Australia, a high-income country with universal healthcare.access, chronic kidney disease, financial toxicity, out-of-pocket costs, quality of life Summary at a glanceAustralian rural patients requiring dialysis or kidney transplantation experience outof-pocket costs that place high levels of stress on their families. Despite living in a Country with universal health insurance, expenses experienced by patients and their

Multimodal approaches for inequality in kidney care: turning social determinants of health into opportunities

“…Financial toxicity perpetuates socially determined barriers to healthcare [18] and it is likely to be more acute in low and low-middle income countries. Scholes-Robertson et al found that 78% of those living with CKD in Australian rural areas (>50 km from specialist kidney services) experienced financial hardship mostly due to cost of transport, medications and nephrologist fees [19], which raises equity concerns even in a high-income country with universal healthcare.…”

Equity and Quality of Global Chronic Kidney Disease Care: What Are We Waiting for?

“…People living in rural and remote Australia experience greater socioeconomic disadvantage, reduced access to primary health care, reduced availability and access to public infrastructure (transport and health services) and face geographical barriers that contribute to delayed referral to kidney specialist services and poorer health outcomes [135,136]. These patients experience high levels of financial insecurity related to managing CKD with and mean quarterly cost of AUS 308 (range AUS 0-4,000) for transportation and AUD 240 (range AUD 0-AUD 2,000) for medications accounting for the greatest out-of-pocket costs [137]. People living in rural and remote areas are also more likely to have lower levels of health literacy than urban counterparts [138][139][140], which may impact their understanding of CKD and treatment strategies [135].…”