Financial Strain Research Articles

Experiences and impacts of out-of-pocket healthcare expenditure on remote Aboriginal families.

Aboriginal Australians face significant health disparities, with hospitalisation rates 2.3 times greater, and longer hospital length of stay, than non-Indigenous Australians. This additional burden impacts families further through out-of-pocket healthcare expenditure (OOPHE), which includes additional healthcare expenses not covered by universal taxpayer insurance. Aboriginal patients traveling from remote locations are likely to be impacted further by OOPHE. The objective of this study was to examine the impacts and burden of OOPHE for rurally based Aboriginal individuals. Participants were recruited through South Australian community networks to participate in this study. Decolonising methods of yarning and deep listening were used to centralise local narratives and language of OOPHE. Qualitative analysis software was used to thematically code transcripts and organise data. A total of seven yarning sessions were conducted with 10 participants. Seven themes were identified: travel, barriers to health care, personal and social loss, restricted autonomy, financial strain, support initiatives and protective factors. Sleeping rough, selling assets and not attending appointments were used to mitigate or avoid OOPHE. Government initiatives, such as the patient assistance transport scheme, did little to decrease OOPHE burden on participants. Family connections, Indigenous knowledges and engagement with cultural practices were protective against OOPHE burden. Aboriginal families are significantly burdened by OOPHE when needing to travel for health care. Radical change of government initiative and policies through to health professional awareness is needed to ensure equitable healthcare access that does not create additional financial hardship in communities already experiencing economic disadvantage.

Disparities in Stress Exposure and Later-Life Disability.

Drawing from cumulative inequality theory and the weathering hypothesis, this study examined the relationship between life-course stress exposure (measured cumulatively and by domains) and the onset of disability in later life among White, Black, U.S.-born Hispanic, and foreign-born Hispanic older adults. Cross-sectional and longitudinal models were estimated using nationally representative data from the Health and Retirement Study (N = 11,483). We used logistic regression models to examine associations between stress exposure and Wave 1 disability (i.e., occurrence), and Weibull-accelerated failure-time models to examine the relationship between stress exposure and age of onset of disability 12-14 years later (i.e., incidence). We tested for moderation between stress and disability by race, ethnicity, and Hispanic nativity. At Wave 1, higher odds of disability occurrence were associated with cumulative stress burden (CSB; odds ratio [OR] = 4.93, 95% confidence interval [CI]: 2.95-8.23). In a model specifying domains of stressors, disability occurrence was associated with childhood financial strain (OR = 1.22, CI: 1.01-1.46), lifetime traumatic events (OR = 1.92, CI: 1.41-2.62), neighborhood disadvantage (OR = 1.32, CI: 1.01-1.73), and major lifetime discrimination (OR = 1.64, CI: 1.12-2.41). Over time, earlier onset of disability was associated with CSB (β = -0.39), childhood traumatic events (β = -0.16), adult financial strain (β = -0.17), everyday discrimination (β = -0.15), and major lifetime discrimination (β = -0.13). The effect of childhood traumatic events on the transition to disability was stronger for U.S.-born Hispanic adults than White adults (occurring 33% earlier). To reduce racial, ethnic, and nativity disparities in disability, it is important to consider the historical and structural disadvantages associated with stress exposure across the life course. It is also important to acknowledge that nativity influences stratification processes associated with disparities in racial and ethnic health trajectories.

Overcoming Geographic Barriers: Surgical Care in Rural Populations

AbstractThis chapter examines the challenges rural Americans face in accessing surgical care, which is characterized by geographical barriers, a decreasing surgical workforce, and unique patient factors. The widening health care disparity between rural and urban residents highlights the need for comprehensive strategies to improve surgical care delivery to rural areas. Focusing on colorectal care delivery, encompassing the spectrum of common and complex care, exemplifies opportunities to optimize care delivery for rural populations. Here, we discuss the complex and unique interplay of challenges within rural hospital infrastructure, workforce shortages, and patient factors emphasizing financial strain, closure of rural hospitals, and limited access to specialty providers and resources. Current evidence focuses on volume–outcome relationships, the safety of common surgical care at rural hospitals, and the impact of rural hospitals joining larger health systems. Strategies to optimize care delivery include site-of-care optimization, improved care coordination, dissemination of specialty expertise, and policy programs to support the rural workforce. Recent federal policies, including the rural emergency hospital program, underscore the delicate balance between sustaining essential local health care services and the financial realities of rural health care delivery. We then conclude with evidence-based strategies to bridge the urban-rural health care gap, ensuring equitable access to high-quality surgical care regardless of geographic location.

Finding light in the darkness: A journey through four miscarriages

This paper explores the profound emotional and physical journey of a couple in The Phillipines who faced the rare medical condition known as Repro-Immuno Deficiency (RID) while trying to conceive. The author and his wife endured the heartbreak of four miscarriages and the financial strain of various medical treatments, eventually leading to the birth of their fifth child. The paper discusses the emotional toll of repeated miscarriages, the challenges of accessing specialised medical care, and the financial burdens they encountered during their journey. It also highlights the support they received from a diverse network of individuals and the significance of their daughter as a symbol of hope and resilience.

Lack of braille labelling and instructions on Chinese pharmaceutical packaging

Braille labels and instructions on medicine packaging are scarce in China, impeding blind individuals’ ability to obtain information about medications. Article 37 of China’s Barrier-Free Environment Creation Law, enacted in September 2023, requires braille labelling and instructions for pharmaceuticals. This provision offers essential legal protection to ensure the safety of blind individuals when using medications. Nevertheless, the use of braille labels and instructions for medicines is hindered by ambiguous statutes, limited social consciousness, financial factors and technological constraints. To promote the use of braille on medicinal labels and instructions, China should bolster its legislation, increase social consciousness, alleviate the financial strain on pharmaceutical manufacturers, foster technological advancement and encourage collaboration and self-governance within the pharmaceutical industry.

Widowhood and multidimensional poverty: Evidence from Nigeria

AbstractPoverty among widows has received little empirical attention in Africa despite women's severe vulnerability to death shock. We provided empirical evidence on widow households' transition in and out of poverty and factors influencing their probability of being in poverty. The Markov transition probabilities show moderate but increasing positive transitions for severely poor widows. Non‐poor widows are stayers who primarily sustain their non‐poor class. The ordered logit estimation shows that higher dependency ratio increases the chances of a widow being severely poor. Being an older widow and having literacy skills reduced the probability that a widow household will be severely poor. Household size and dependency ratio are noted to play important roles in the probability of transitions across poverty classes as shown by the estimated multinomial logit model. These findings are robust to alternative poverty measure, estimation method and different set of weights. Generally, the results echo the need for social safety nets to cushion widows' financial strains. Life insurance policy for spouses, increased sensitization of widows of their rights and adult education programmes targeted at widows could mitigate the negative impact of widowhood on women.

Exosomes derived from mesenchymal stem cells in diabetes and diabetic complications.

Diabetes, a group of metabolic disorders, constitutes an important global health problem. Diabetes and its complications place a heavy financial strain on both patients and the global healthcare establishment. The lack of effective treatments contributes to this pessimistic situation and negative outlook. Exosomes released from mesenchymal stromal cells (MSCs) have emerged as the most likely new breakthrough and advancement in treating of diabetes and diabetes-associated complication due to its capacity of intercellular communication, modulating the local microenvironment, and regulating cellular processes. In the present review, we briefly outlined the properties of MSCs-derived exosomes, provided a thorough summary of their biological functions and potential uses in diabetes and its related complications.

Investigating the Relationship Between Unemployment Rate and Alaskas Unique Universal Basic Income

The distribution of the Alaska Permanent Fund Dividend (PFD) has existed for over four decades. Similar to a universal basic income PFD entitles each Alaska resident to an equitable portion of an annual government allocation. This paper examines how Alaskas Permanent Fund Dividend impacted Alaskas unemployment rate before and during the pandemic. It also evaluates the merits of a universal basic income before and during a pandemic. This paper demonstrates a positive association between the unemployment rate and the distribution of the Alaska Permanent Fund Dividend. As unemployment rates increase, the dependence on the additional income offered by the Alaska Permanent Fund Dividend or Universal Basic Income becomes increasingly evident. In other words, the PFD is designed to distribute the state's resource wealth among its residents and appears to function as a stabilizing influence during economic downturns. It serves as a financial safety net for individuals experiencing job losses, potentially alleviating financial strain on both individuals and families, and mitigating the adverse effects linked to elevated unemployment rates.

Trapped in vicious cycles: unraveling the health experiences and needs of adults living with socioeconomic insecurity

BackgroundThis study explores the role of health in daily life and needs of Dutch adults (aged 25–49) experiencing one or more forms of socioeconomic insecurity stemming from their financial, housing, or employment situations.Methods28 in-depth, semi-structured interviews were conducted in the Netherlands between October 2022 and February 2023. The interview guide included questions on participants’ socioeconomic situation, the role of health in their daily lives, their health-related and broader needs. Data was interpreted using inductive reflexive thematic analysis. An advisory board consisting of adults with lived experiences of socioeconomic insecurity were consulted at multiple stages of the study (recruitment, interview guide, interpretation of results).ResultsHousing insecurity was widely experienced by participants. When asked about their financial situation, most participants expressed having no issues getting by, but later on, described vigorous efforts to minimize expenses. Participants’ narratives revealed four key themes in relation to the role of health in daily life and associated needs. Firstly, socioeconomic insecurity led to diminished control over life, which led to the disruption of routines. Secondly, experiencing socioeconomic insecurity compelled participants to prioritize stress reduction and mental health improvement through calming yet potentially damaging coping mechanisms. Thirdly, those who experienced little opportunity for improvement in their already long-lasting socioeconomic insecurity shared a sense of stagnation in life, which co-occurred with stagnation in unhealthy routines and diminished well-being. Fourthly, participants expressed the need for someone to speak with. This support may help participants regain control over their lives, identify opportunities for more socioeconomic security, and focus on increased health and well-being.ConclusionsThis study sheds light on the challenges individuals face in dealing with socioeconomic insecurity, how it may affect their health, and their needs. Gaining perspective for improved socioeconomic security and having accessible professional support tailored to self-identified needs could have health-promoting effects for individuals living with socioeconomic insecurity. It is recommended to integrate professional support and assistance regarding social security into health policies and interventions. In future research, measures of financial strain should be adjusted to include the effort needed to get by.

Navigating frugality and creativity urgencies: the role of diagnostic use of budgets and goal clarity

Organizations increasingly promote individual creativity as a strategy to manage their performance and financial strain. Drawing on self-regulation and goal-setting theories, this study examines whether the diagnostic use of budgets stifles or stimulates managers’ creativity directly or indirectly through frugal spending behaviour and perceived goal clarity. Budgetary controls and frugal spending behaviour—with the focus on conserving resources and constraining spending—have traditionally been suggested as hindering individual creativity. However, by analysing survey data collected from middle-level managers in Indonesia, our findings show that the diagnostic use of budgets increases managers’ frugal spending behaviour which, in turn, enhances their creativity. Furthermore, the diagnostic use of budgets increases managers’ perceived goal clarity, with goal clarity and frugal spending behaviour fully mediating the relationship between the diagnostic use of budgets and creativity. The study contributes to the budgeting literature by showing that diagnostic use of budgets encourages managers’ frugal spending behaviour to effectively manage organisational costs and stimulate their creativity.

Uptake and outcomes of implementing non-invasive prenatal testing (Prenatal Reflex DNA testing) into first-trimester contingent screening protocols for trisomy 21, 18, 13: A study protocol

Chromosomal anomalies (CAs), such as trisomies 21 (T21), 18 (T18), and 13 (T13), are significant contributors to birth defects and genetic conditions worldwide. Cell-free fetal DNA testing (cff-DNA) is the preferred method for detecting these trisomies from maternal blood samples. However, its adoption is hindered by high costs and complexities. To enhance efficiency and reduce financial strain, we propose a practical protocol. This approach involves a contingent test based on biochemical and ultrasound markers commonly used in clinical practice. We aim to leverage cost-effective contingent prenatal DNA screening for trisomies 21, 18, and 13. This is integrated into standard aneuploidy screening during the first trimester at prenatal centers. Screening participants are categorized into four pathways (1T Quad, 1T Combined, 1T Expanded Combined, and 1T Expanded Combined + Ductus Venosus Pulsatility Index) based on biochemical markers (PAPP-A, Free β-hCG, PlGF, AFP) and ultrasound indicators (NT, DV-PI) as per FMF guidelines. Pregnant subjects (Low/High/Moderate Risk) with a high chance of affected pregnancy (1:1000 ≤ Risk < 1:10) undergo the DNA reflex screening test using stored plasma samples.

Fines, Fees, and Families: Monetary Sanctions As Stigmatized Intergenerational Exchange

ABSTRACT This study examines the intergenerational consequences of court-imposed monetary sanctions for parents and children. Research on punishment and families has generally focused on imprisonment, yet monetary sanctions are far more commonly imposed. We extend research on intergenerational financial exchanges to conceptualize payment of monetary sanctions as stigmatized transfers, analyzing 70 semi-structured interviews with debtholders in Minnesota. Adult children reported perceiving anger and financial strain from family members who provide assistance. Those with minor children expressed hopelessness, stress, and financial strain, as they prioritized basic needs over meeting their outstanding financial obligations. We conclude by discussing the implications of these intergenerational impacts for research, law, and policy.

Adding insult to injury: Living in a remote location increases the burden of gift expenses among the rural poor in China

AbstractBased on data from the China Labor‐force Dynamics Survey (CLDS), our study examines how geographical remoteness impacts farmers' gift expense burden. Farmers' gift expense burden increases significantly as the distance from the village to the county‐level city increases. Two key mechanisms for more remote rural areas exacerbate farmers' gift expense burden: stronger reliance on neighbours and relatives for assistance and more concentrated authority among local officials. Our research offers new perspectives on disparities in gift expense burden among farmers in developing countries and suggests viable avenues to alleviate their financial strain.

Parenting Amid Shadows: Exploring the Child-Rearing Experiences of Wives of Individuals With Alcohol Use Disorder.

The pervasive impact of alcohol use disorder (AUD) within families, particularly on parenting roles in Kerala, India, necessitates an in-depth exploration. This study aims to uncover the unique challenges and coping strategies employed by wives of individuals with AUD against a backdrop of societal stigma and economic hardship. This study, employing a qualitative narrative research design, delves into the experiences of 30 wives of men with AUD in Kerala. The study delves into the complexities of navigating parenting responsibilities amid challenges related to AUD, employing in-depth interviews with the aid of a semi-structured interview guide conducted in Malayalam.​​​​​The researchers used narrative analysis to extract the themes related to coping mechanisms, resilience, and the impact on children's psychological health. The study highlights significant emotional and social burdens on wives, including solo parenting, financial strain, and social stigma. Despite these challenges, the resilience and adaptive strategies of these women stand out, with extended family support, community resources, and personal beliefs playing crucial roles in their coping mechanisms. The study points out variations in coping strategies across different socio-economic and educational backgrounds. The findings underscore the necessity for comprehensive support systems sensitive to the socio-demographic differences among families affected by AUD. Tailored interventions that enhance access to professional support, foster community solidarity, and provide economic assistance are critical. Moreover, efforts to reduce stigma and promote understanding are essential for improving the psychological health and overall quality of life of these families.

Experiences of family caregivers in dealing with cases of advanced breast cancer: a qualitative study of the sociocultural context in Punjab, Pakistan

BackgroundPatients with advanced breast cancer require consistent help and support from family caregivers. These caregivers often endure financial burdens and psychological stress, with their experiences significantly influenced by sociocultural factors. This study aims to explore the experiences of family caregivers of advanced breast cancer patients in Punjab province, Pakistan.MethodsData was collected through in-depth interviews with fifteen family caregivers of advanced breast cancer patients in three major cities of Punjab, Pakistan. Caregivers, who had been in close contact with the patient for the last two years, were purposively sampled from five major hospitals. The data was analyzed using thematic analysis.ResultsThe study revealed that the experiences of family caregivers are deeply rooted in the sociocultural context. Key themes identified include social responsibility and cultural reciprocity norms; limited awareness and mobility options for caregivers; financial responsibility and strain; impacts of beauty myths and shyness on caregiving attitudes and decisions; the stressful and emotional nature of caregiving; treatment perspectives influenced by social groups; challenges in consulting male physicians and associated stigma; the role of religious beliefs in caregiving; and stress management, with religion often being a coping mechanism. These factors can contribute to delayed treatment decisions for patients.ConclusionsFamily caregivers are crucial in facilitating timely treatment decisions for advanced breast cancer patients in the Pakistani context. To minimize treatment delays and alleviate caregiver stress, addressing sociocultural barriers in care-seeking is essential. A tailored approach, considering sociocultural and religious factors, is imperative for the management and early diagnosis of breast cancer, necessitating appropriate policymaking and implementation.

Prevalence of infertility and barriers to family building among male physicians.

Fertility declines with increasing age and physicians often delay childbearing beyond prime reproductive years for the sake of medical training. However, the risks of infertility in male physicians compared to the general population remain poorly studied. To characterize rates of infertility among male physicians and identify barriers in access to fertility care and family building. Between June 2022 and December 2022, male physicians were invited to complete a questionnaire regarding fertility and family building. Surveys were disseminated electronically via social media and professional medical societies using Qualtrics (Provo, UT). Two hundred thirty-five responses were included in the final analysis. The mean age of respondents was 36.3±7.4 years. Of 151 respondents with children or currently attempting to have children, 66 (43.7%) delayed family building due to their medical training or career. The most influential factors affecting timing of children were lack of flexibility in schedule, lack of time, stress, and financial strain. Forty-three (18.3.%) respondents had seen a doctor for fertility evaluation; an additional 12 (5.1%) said they considered doing so but did not, mostly due to being too busy. Sixty (25.5%) had undergone semen testing in the past. Thirty-one (13.2%) reported a diagnosis of fertility issues in either themselves or their partner. Twenty-seven (11.5%) endorsed either them or their partner having undergone assistive reproductive technologies or other procedures for infertility. A significant proportion of male physicians delayed building their family or seeking fertility evaluation due to their medical career. Around 23.4% of male physicians have either seen or considered seeing a physician for fertility evaluation, suggesting a high prevalence of infertility in this cohort. Our results indicate a need for interventions to support family building and fertility evaluation and treatment among male physicians.

Sex-specific prevalence and correlates of possible undiagnosed obstructive sleep apnea in rural Canada

BackgroundObstructive Sleep Apnea (OSA) has been under-investigated in rural communities, particularly through a sex/gender lens. The purpose of this study was to examine the prevalence and correlates of OSA risk among rural-dwelling women and men in Saskatchewan, Canada.MethodsParticipants for this cross-sectional study were 2340 women and 2030 men living in rural Saskatchewan, Canada and were without a prior diagnosis of OSA. The dependent variable, OSA risk, was estimated from self-reported symptoms of OSA and percentage body fat. Independent variables included socio-demographic characteristics, health behaviors, comorbidities, and quality of life indicators. Multivariable logistic regression was the primary statistical technique employed, conducted separately for women and men.ResultsA greater proportion of men (30.1%) than women (19.4%) were at high risk of OSA. While many of the correlates of OSA risk were similar for women and men, sex differences emerged for marital status, educational attainment, financial strain, depression, asthma, and perceptions of community support.ConclusionA sizable minority of rural women and men may have possible undiagnosed OSA, which in turn, is associated with substantial comorbidity and reduced quality of life. Additional research with enhanced measurement and a longitudinal design is required to test the veracity of these findings and further clarify the role of sex/gender in relation to OSA risk in rural adults.

Understanding social needs screening and demographic data collection in primary care practices serving Maryland Medicare patients

BackgroundHealth outcomes are strongly impacted by social determinants of health, including social risk factors and patient demographics, due to structural inequities and discrimination. Primary care is viewed as a potential medical setting to assess and address individual health-related social needs and to collect detailed patient demographics to assess and advance health equity, but limited literature evaluates such processes.MethodsWe conducted an analysis of cross-sectional survey data collected from n = 507 Maryland Primary Care Program (MDPCP) practices through Care Transformation Requirements (CTR) reporting in 2022. Descriptive statistics were used to summarize practice responses on social needs screening and demographic data collection. A stepwise regression analysis was conducted to determine factors predicting screening of all vs. a targeted subset of beneficiaries for unmet social needs.ResultsAlmost all practices (99%) reported conducting some form of social needs screening and demographic data collection. Practices reported variation in what screening tools or demographic questions were employed, frequency of screening, and how information was used. More than 75% of practices reported prioritizing transportation, food insecurity, housing instability, financial resource strain, and social isolation.ConclusionsWithin the MDPCP program there was widespread implementation of social needs screenings and demographic data collection. However, there was room for additional supports in addressing some challenging social needs and increasing detailed demographics. Further research is needed to understand any adjustments to clinical care in response to identified social needs or application of data for uses such as assessing progress towards health equity and the subsequent impact on clinical care and health outcomes.

What are we worried about? Midlife married couples' financial concerns about their retirement

AbstractObjectiveThis study explored how marital financial collaboration and approval along with financial constructs predicted midlife couples' reports of retirement financial concerns.BackgroundRetirement is an expected time of life that many couples plan for in advance. Despite knowing that years of life without regular income are anticipated, many people experience financial strain in retirement, which can impact their marital happiness.MethodData for this study came from a sample of 324 midlife (Mage = 44 years) couples that participated in the Flourishing Families study. We examined predictors of financial worries for retirement using dyadic probit regression models.ResultsResults suggested that both husbands and wives worried about having insufficient income and heavy debt in retirement, and that husbands had particular concerns about excess spending. Findings from predictive models suggested that husbands and wives both reported that better financial collaboration, husbands' approval of partners' financial behaviors, better physical health, and to some degree higher income, higher education, and having retirement savings, were protective against financial worries for retirement. In contrast, wives' reports of having retirement benefits and working more hours per week were risk factors.ConclusionMarital financial collaboration and approval of partner financial responsibility by both members of dyads may have lifelong benefits, including as couples prepare for retirement.ImplicationsEfforts to provide greater access to retirement savings plans may also support couples from various social and economic backgrounds. Findings suggest that marital happiness in retirement could be increased as spouses work together in financial aspects of their lives.

Feasibility and acceptability of measuring prenatal stress in daily life using smartphone-based ecological momentary assessment and wearable physiological monitors.

High levels of stress during pregnancy can have lasting effects on maternal and offspring health, which disproportionately impacts families facing financial strain, systemic racism, and other forms of social oppression. Developing ways to monitor daily life stress during pregnancy is important for reducing stress-related health disparities. We evaluated the feasibility and acceptability of using mobile health (mHealth) technology (i.e., wearable biosensors, smartphone-based ecological momentary assessment) to measure prenatal stress in daily life. Fifty pregnant women (67% receiving public assistance; 70% Black, 6% Multiracial, 24% White) completed 10 days of ambulatory assessment, in which they answered smartphone-based surveys six times a day and wore a chest-band device (movisens EcgMove4) to monitor their heart rate, heart rate variability, and activity level. Feasibility and acceptability were evaluated using behavioral meta-data and participant feedback. Findings supported the feasibility and acceptability of mHealth methods: Participants answered approximately 75% of the surveys per day and wore the device for approximately 10hours per day. Perceived burden was low. Notably, participants with higher reported stressors and financial strain reported lower burden associated with the protocol than participants with fewer life stressors, highlighting the feasibility of mHealth technology for monitoring prenatal stress among pregnant populations living with higher levels of contextual stressors. Findings support the use of mHealth technology to measure prenatal stress in real-world, daily life settings, which shows promise for informing scalable, technology-assisted interventions that may help to reduce health disparities by enabling more accessible and comprehensive care during pregnancy.