Abstract
BackgroundOut of pocket expenditure (OOPE) on healthcare is related to the burden of illness and the number of chronic conditions a patient experiences, but the relationship of these costs to particular conditions and groups of conditions is less studied. This study examines the effect on OOPE of various morbidity groupings, and explores the factors associated with a ‘heavy financial burden of OOPE’ defined by an expenditure of over 10% of equivalised household income on healthcare.MethodsData were collected from 4,574 senior Australians using a stratified sampling procedure by age, rurality and state of residence. Natural clusters of chronic conditions were identified using cluster analysis and clinically relevant clusters based on expert opinion. We undertook logistic regression to model the probability of incurring OOPE, and a heavy financial burden; linear regression to explore the significant factors of OOPE; and two-part models to estimate the marginal effect of factors on OOPE.ResultsThe mean OOPE in the previous three months was AU$353; and 14% of respondents experienced a heavy financial burden. Medication and medical service expenses were the major costs. Those who experienced cancer, high blood pressure, diabetes or depression were likely to report higher OOPE. Patients with cancer or diabetes were more likely than others to face a heavy burden of OOPE relative to income. Total number of conditions and some specific conditions predict OOPE but neither the clusters nor pairs of conditions were good predictors of OOPE.ConclusionsTotal number of conditions and some specific conditions predict both OOPE and heavy financial burden but particular comorbid groupings are not useful in predicting OOPE. Low-income patients pay a higher proportion of income than the well-off as OOPE for healthcare. Interventions targeting those who are likely to face severe financial burdens due to their health could address some of these differences.
Highlights
Out of pocket expenditure (OOPE) on healthcare is related to the burden of illness and the number of chronic conditions a patient experiences, but the relationship of these costs to particular conditions and groups of conditions is less studied
The aim of this study is to examine the roles of specific chronic conditions and of comorbid structures on the level of OOPE, using a range of measures and clustering arrangements, and to explore the significant variables associated with a high burden of healthcare costs reflected by over 10% of income being expended on OOPE
The sample was similar to the average Australian population in terms of estimated prevalence of chronic conditions in the similar age group, except that the sample had higher prevalence of high blood pressure (HBP), history of cancer diagnosis and a lower prevalence of arthritis [17]
Summary
Out of pocket expenditure (OOPE) on healthcare is related to the burden of illness and the number of chronic conditions a patient experiences, but the relationship of these costs to particular conditions and groups of conditions is less studied. Apart from variation across health care settings [10,11,12], OOPE is likely to be influenced by a range of factors including, but not limited to, the type, total number and severity of diseases and patients’ socio-economic status [7,12,13,14] The level of this spending varies by age and insurance coverage, among other characteristics [7]. McRae et al found that was the total number a significant factor but that people with multiple chronic conditions tended to be from lower income groups They found that each additional chronic condition added an estimated 46% to the likelihood of a person facing a severe financial burden due to health costs [17]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call