Economic hardship associated with managing chronic illness: a qualitative inquiry
1 The Australian Primary Health Care Research Institute, The College of Medicine, Biology and Environment, The Australian National University, Building 62, Mills Rd, Canberra, ACT 0200, Australia
2 The Faculty of Nursing and Midwifery, The University of Sydney, 88 Mallett Street, Camperdown, NSW 2050, Australia
3 Menzies Centre for Health Policy, The University of Sydney, Victor Coppleson Bldg (D02), Camperdown, NSW 2006, Australia
4 The George Institute for International Health, Level 10 King George V Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia
5 Menzies Centre for Health Policy, The College of Medicine, Biology and Environment, The Australian National University, Building 131, Garran Road, Canberra, ACT 0200, Australia
6 The John Curtin School of Medical Research, The College of Medicine, Biology and Environment, The Australian National University, Building 131, Garran Road, Canberra, ACT 0200, Australia
BMC Health Services Research 2009, 9:182 doi:10.1186/1472-6963-9-182Published: 9 October 2009
Chronic illness and disability can have damaging, even catastrophic, socioeconomic effects on individuals and their households. We examined the experiences of people affected by chronic heart failure, complicated diabetes and chronic obstructive pulmonary disease to inform patient centred policy development. This paper provides a first level, qualitative understanding of the economic impact of chronic illness.
Interviews were conducted with patients aged between 45 and 85 years who had one or more of the index conditions and family carers from the Australian Capital Territory and Western Sydney, Australia (n = 66). Content analysis guided the interpretation of data.
The affordability of medical treatments and care required to manage illness were identified as the key aspects of economic hardship, which compromised patients' capacity to proactively engage in self-management and risk reduction behaviours. Factors exacerbating hardship included ineligibility for government support, co-morbidity, health service flexibility, and health literacy. Participants who were on multiple medications, from culturally and linguistically diverse or Indigenous backgrounds, and/or not in paid employment, experienced economic hardship more harshly and their management of chronic illness was jeopardised as a consequence. Economic hardship was felt among not only those ineligible for government financial supports but also those receiving subsidies that were insufficient to meet the costs of managing long-term illness over and above necessary daily living expenses.
This research provides insights into the economic stressors associated with managing chronic illness, demonstrating that economic hardship requires households to make difficult decisions between care and basic living expenses. These decisions may cause less than optimal health outcomes and increased costs to the health system. The findings support the necessity of a critical analysis of health, social and welfare policies to identify cross-sectoral strategies to alleviate such hardship and improve the affordability of managing chronic conditions. In a climate of global economic instability, research into the economic impact of chronic illness on individuals' health and well-being and their disease management capacity, such as this study, provides timely evidence to inform policy development.