We can't afford my chronic illness! The out-of-pocket burden associated with managing chronic obstructive pulmonary disease in western Sydney, Australia

Abstract

The costs associated with living with COPD make it difficult for patients and their families to afford necessary living expenses while also paying health care expenses. This is alarming within Australia where a well-funded universal health insurance system is in place. Rising co-payments for medications and private medical consultations, poorly subsidised health support (e.g. home oxygen), non-health logistics (e.g. transport) and eligibility barriers for existing social support are making chronic illness management seriously economically stressful, especially for those with low incomes, including the retired.

The consequences of patient charges for prescription drugs in Canada: a cross-sectional survey

“…6 High rates of trade-offs have also been shown among patients with chronic obstructive pulmonary disease in Australia and those with arthritis and diabetes in the US. [23][24][25] Prescribers should also be aware that cost-related nonadherence was not limited to expensive medications. This is consistent with our team's qualitative findings suggesting that patients' very individual decisions about taking particular prescriptions are driven primarily by their own assessment of the importance of the medication and the flexibility of their budget.…”

Socioeconomic Impact of Cancer in Member Countries of the Association of Southeast Asian Nations (ASEAN): the ACTION Study Protocol

“…Similar questions have been successfully used in several studies investigating economic hardship (Heeley et al, 2009;Wei et al, 2010;Essue et al, 2011;Hackett et al, 2011).…”

Multi-morbidity: a system design challenge in delivering patient-centred care

“…[5][6][7] Economic hardships associated with self-management of multiple chronic illnesses arose through the accumulation of related out-of-pocket expenses. 6,8 A single chronic illness, type two diabetes mellitus for example, might require lifestyle changes such as dietary modification and exercise, neither of which are covered by financial rebates, and might not of themselves cause undue financial pressure. However, compounding incidental expenses associated with the self-management of several illnesses, such as home oxygen in the case of comorbid COPD, the out-of-pocket costs multiply.…”

“…The Medical Benefits Scheme, Pharmaceutical Benefits Scheme and Medicare rebates do not cover all expenses, leaving some patients with challenging out-of-pocket expenses. 8 Although informal family carers minimise the financial and workforce pressures on the public health system, this comes at a cost to the carer. Fifty-seven percent of the SCIPPS carers were managing their own chronic condition and 71% of the carers were the spouse.…”

“…SCIPPS found that in some cases, family members had to leave the workforce or reduce their paid working hours in order to assume the caring role. 8 As this burden is incompletely compensated by Centrelink, some participants reported resulting economic hardship 5,8 and frustration caused by role and financial adjustment, compounding the pressures inherent to the carer role. Geographic distance between family members contributed to escalating stress levels as family attempted to care for patients in absentia.…”