The cost of poor adjustment to chronic illness: lessons from three studies

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This paper summarizes information about expenditures for people with chronic illness as a function of their psychosocial adjustment to illness. Three studies are discussed: two prospective baseline surveys and one historic cohort analytic study. Each was conducted between 1988 and 1993 in Southern Ontario, Canada in tertiary centres which were treating patients recently referred to a specialty medical clinic for one of 13 types of chronic physical illnesses. All three studies used the same measures: The Psychosocial Adjustment to Illness Scale-Self Report (PAIS-SR) (Derogatis & Lopez 1983) and the Health and Social Service Utilization Inventory (Browne et al. 1990) which translates utilization into a measure of dollar expenditure for utilization. Poor adjustment to chronic illness exceeded the importance of disease severity and levels of disability in explaining a disproportionate level of expenditures for a subgroup of people (34–55%) attending specialty medical clinics. The cost of providing more comprehensive health and social care for this group could be less than the amount spent in maintaining their poorly adjusted state by providing only medical care.