Living with economic hardship at the end of life

Essue, Beverley M; Beaton, Angela; Hull, Catherine; Belfrage, John; Thompson, Stanley R.; Meachen, Michele; Gillespie, James

doi:10.1136/bmjspcare-2013-000460

Cited by 16 publications

(28 citation statements)

References 15 publications

(13 reference statements)

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“…[5][6][7][8][9] Each additional chronic disease adds 46% to the likelihood that a person faces severe financial difficulties, often compounding existing levels of financial stress. 10,11 What is the impact of increasing co-payments on healthcare access and outcomes?…”

Section: What Out-of-pocket Expenditures Do Australian Health Consumementioning

confidence: 99%

“…20,21 Gap payments and PBS co-payments impact most significantly on the poor -those who are most likely to suffer ill health in the first place. [5][6][7][8]22 The empirical evidence evaluating the effect of co-payment on healthcare demand clearly identifies that individuals with lower incomes reduce their use of healthcare services to a greater extent in response to increased copayments. 20,21 Limited empirical evidence exists to analyse the long-term health effects of co-payments for health care, 20 although there is some indication that reduced access and utilisation of otherwise cost-effective health care result from higher co-payments, particularly among those with chronic illnesses.…”

Section: What Out-of-pocket Expenditures Do Australian Health Consumementioning

confidence: 99%

“…Furthermore, the Medicare and PBS safety net programs are not easy to use, with patients reporting problems understanding safety net requirements and being unaware of their eligibility. 7,22 Other challenges cited include: program timing (the need to re-qualify each calendar year); complex administrative requirements (inconsistent processes, a need to record personal spending, eligibility differences for families compared with individuals); and program inequities (couples qualify before singles in elderly households).…”

Section: Safety Nets and Other Offsetsmentioning

confidence: 99%

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Co-payments for health care: what is their real cost?

Laba

Usherwood

Leeder

et al. 2015

Aust. Health Review

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Abstract. Based on the premise that current trends in healthcare spending are unsustainable, the Australian Government has proposed in the recent Budget the introduction of a compulsory $7 co-payment to visit a General Practitioner (GP), alongside increased medication copayments. This paper is based on a recent submission to the Senate Inquiry into the impact of out-of-pocket costs in Australia. It is based on a growing body of evidence highlighting the substantial economic burden faced by individuals and families as a result of out-of-pocket costs for health care and their flow-on effects on healthcare access, outcomes and long-term healthcare costs. It is argued that a compulsory minimum co-payment for GP consultations will exacerbate these burdens and significantly undermine the tenets of universal access in Medicare. Alternative recommendations are provided that may help harness unsustainable health spending while promoting an equitable and fair health system.

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Section: What Out-of-pocket Expenditures Do Australian Health Consumementioning

confidence: 99%

Section: What Out-of-pocket Expenditures Do Australian Health Consumementioning

confidence: 99%

Section: Safety Nets and Other Offsetsmentioning

confidence: 99%

See 1 more Smart Citation

Co-payments for health care: what is their real cost?

Laba

Usherwood

Leeder

et al. 2015

Aust. Health Review

View full text Add to dashboard Cite

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“…Of the 17 papers reviewed that constituted the final data set, there were 11 qualitative, three quantitative and three mixed methods papers, encompassing metropolitan, regional and rural studies in Victoria, New South Wales, South Australia and Western Australia. Two studies stated their face to face interviews were conducted with carers in the presence of the patient ( Essue et al., 2015 ; McConigley et al., 2010 ). Bereaved carers were the focus of ten studies with predominantly current carers the focus of the remaining seven studies.…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen of the 16 papers discussed the carers’ physical, emotional needs and/or health status as a result of undertaking the caring role ( Aoun et al., 2010 ; Dembinsky, 2014 ; Essue et al., 2015 ; Hatcher et al., 2014 ; Heidenreich et al., 2014 ; Keesing et al., 2011 ; Kenny et al., 2010 ; Lee et al., 2009 ; Mason & Hodgkin, 2019 ; McConigley et al., 2010 ; McNamara & Rosenwax, 2010 ; O’Connor et al., 2009 ; Sekelja et al., 2010 ; Wong & Ussher, 2009 ). Carers reported fatigue and exhaustion and found it hard to balance all their normal roles, which for some included caring for elderly parents or grandchildren ( Lee et al., 2009 ).…”

Section: Resultsmentioning

confidence: 99%

Understanding the Needs of Australian Carers of Adults Receiving Palliative Care in the Home: A Systematic Review of the Literature

Miller

Porter

2021

SAGE Open Nursing

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Introduction Caring for someone at home requiring palliative care is an ominous task. Unless the current support systems are better utilised and improved to meet the needs of those carers, the demand for acute hospital admissions will increase as the Australian population ages. The aim of this review was to examine the needs of unpaid carers who were caring for adults receiving palliative care in their home in Australia. Methods: A systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines between 2008–2020. Results: Only Australian papers were selected due to the intent to understand carers’ needs in the Australian context and 17 papers made up the final data set. Four themes emerged: 1) Perceived factors influencing caregiving; 2) Perceived impact and responses to caregiving; 3) Communication and information needs; and 4) Perceptions of current palliative support services and barriers to uptake. Conclusion: Carers reported satisfaction and positive outcomes and also expressed feeling unprepared, unrecognised, stressed and exhausted.

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Association Between Financial Distress with Patient and Caregiver Outcomes in Home-Based Palliative Care: A Secondary Analysis of a Clinical Trial

et al. 2022

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Background Serious illness often causes financial hardship for patients and families. Home-based palliative care (HBPC) may partly address this. Objective Describe the prevalence and characteristics of patients and family caregivers with high financial distress at HBPC admission and examine the relationship between financial distress and patient and caregiver outcomes. Design, Settings, and Participants Data for this cohort study were drawn from a pragmatic comparative-effectiveness trial testing two models of HBPC in Kaiser Permanente. We included 779 patients and 438 caregivers from January 2019 to January 2020. Measurements Financial distress at admission to HBPC was measured using a global question (0–10-point scale: none=0; mild=1–5; moderate/severe=6+). Patient- (Edmonton Symptom Assessment Scale, distress thermometer, PROMIS-10) and caregiver (Preparedness for Caregiving, Zarit-12 Burden, PROMIS-10)-reported outcomes were measured at baseline and 1 month. Hospital utilization was captured using electronic medical records and claims. Mixed-effects adjusted models assessed survey measures and a proportional hazard competing risk model assessed hospital utilization. Results Half of the patients reported some level of financial distress with younger patients more likely to have moderate/severe financial distress. Patients with moderate/severe financial distress at HBPC admission reported worse symptoms, general distress, and quality of life (QoL), and caregivers reported worse preparedness, burden, and QoL (all, p <.001). Compared to patients with no financial distress, moderate/severe financial distress patients had more social work contacts, improved symptom burden at 1 month (ESAS total score: −4.39; 95% CI: −7.61, −1.17; p <.01), and no increase in hospital-based utilization (adjusted hazard ratio: 1.11; 95% CI: 0.87–1.40; p =.41); their caregivers had improved PROMIS-10 mental scores (+2.68; 95% CI: 0.20, 5.16; p =.03). No other group differences were evident in the caregiver preparedness, burden, and physical QoL change scores. Conclusion These findings highlight the importance and need for routine assessments of financial distress and for provision of social supports required to help families receiving palliative care services.

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Living with economic hardship at the end of life

Cited by 16 publications

References 15 publications

Co-payments for health care: what is their real cost?

Co-payments for health care: what is their real cost?

Understanding the Needs of Australian Carers of Adults Receiving Palliative Care in the Home: A Systematic Review of the Literature

Association Between Financial Distress with Patient and Caregiver Outcomes in Home-Based Palliative Care: A Secondary Analysis of a Clinical Trial

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