The real price of health: a mixed methods study examining the influence of income on strategies used by people with chronic conditions to manage the out-of-pocket costs of health in Australia

Abstract

Introduction: People living with chronic conditions face a disproportionate financial burden in managing their health. Despite Medicare’s aim to ensure equitable access to health care and medicines, people with chronic conditions face high out-of-pocket costs (OOPCs) and the burden is amplified by multimorbidity, which increases the frequency and range of health care needed. Aim: To investigate strategies people with chronic conditions use to manage the OOPC of health in relation to income and other demographic factors. Methods: A mixed methods study including: (1) semi-structured interviews (N = 57) and (2) a cross-sectional survey (N = 284) of people with chronic conditions exploring strategies used to manage the OOPC of health and comparing these across six income brackets: (1) $0–18,000, (2) $18,001–$45,000, (3) $45,001–$80,000, (4) $80,001–120,000, (5) $120,001–$180,000 and (6) >$180,000. Data were analysed using: (1) framework analysis and (2) comparative and multiple logistic regression models comparing income and adjusting for other demographics. Results: (1) Budgetary strategies, most often reported by people earning ≤$80,000, included foregoing basic necessities to afford health care, rationing medications or delaying care. (2) 82.5% of survey participants reported cutting back on health consultations due to OOPC, including GP, specialist, and allied health visits. Earning <$45,000/annum was significantly (5%) associated with making greater healthcare cutbacks compared to earning > $180,000. When comparing the effects of income and multimorbidity, multimorbidity had a larger impact on healthcare cutbacks (explaining 4.9% of the variance vs 2.3%), and when combined, they explained 10.9% of all healthcare cutbacks. Conclusion: These findings highlight the current burden of the OOPC of health care for people with chronic conditions in Australia. While income offers some buffers, it is insufficient in the face of growing multimorbidity and health care complexity. Policy responses must address groups affected by income and multimorbidity to address the cumulative burden experienced by people with chronic conditions