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

摘要

Objectives: To examine the household economic consequences that are associated with out-of-pocket spendingnfor the care and management of chronic obstructive pulmonary disease (COPD).nMethods: A cross-sectional study. A self-administered questionnaire was posted to all patients enrolled (n 5n656) in the Respiratory Ambulatory Care Service in western Sydney, Australia, between 1 January 2001 andn31 August 2008. Two hundred and eighteen completed questionnaires were received.nResults:One hundred and sixty-nine (78%) respondents experienced economic hardship whilemanaging theirnillness. Fifty-nine (27%) reported being unable to pay for medical or dental expenses, 38 (18%) were unable tonpay for medication, 59 (27%) were unable to pay rent or mortgage and 40 (19%) were unable to pay utility bills.nRespondents experiencing economic hardship paid more out-of-pocket overall (u0002 x5AUD$544 versusnu0002 x5AUD$280; t148 522.03, P 5 0.04) and for medications and oxygen specifically (u0002 x5AUD$247 versusnu0002 x5AUD$125; t83 523.98, P < 0.0001). Fifty-six (46%) respondents had catastrophic levels of out-of-pocketnspending which made them 7.5 times more likely to experience economic hardship (95% confidence intervaln[CI]: 1.2–46.3).nConclusions: The costs associated with living with COPD make it difficult for patients and their families tonafford necessary living expenses while also paying health care expenses. This is alarming within Australianwhere a well-funded universal health insurance system is in place. Rising co-payments for medications andnprivate medical consultations, poorly subsidised health support (e.g. home oxygen), non-health logistics (e.g.ntransport) and eligibility barriers for existing social support are making chronic illness managementnseriously economically stressful, especially for those with low incomes, including the retired.