title: We can't afford my chronic illness! The out-of-pocket burden associated with managing chronic obstructive pulmonary disease in western Sydney, Australia.
abstract: OBJECTIVE
  To examine the household economic consequences that are associated with out-of-pocket spending for the care and management of chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  A cross-sectional study. A self-administered questionnaire was posted to all patients enrolled (n = 656) in the Respiratory Ambulatory Care Service in western Sydney, Australia, between 1 January 2001 and 31 August 2008. Two hundred and eighteen completed questionnaires were received.
  
  
  RESULTS
  One hundred and sixty-nine (78%) respondents experienced economic hardship while managing their illness. Fifty-nine (27%) reported being unable to pay for medical or dental expenses, 38 (18%) were unable to pay for medication, 59 (27%) were unable to pay rent or mortgage and 40 (19%) were unable to pay utility bills. Respondents experiencing economic hardship paid more out-of-pocket overall (=AUD$544 versus =AUD$280; t(148) = -2.03, P = 0.04) and for medications and oxygen specifically (=AUD$247 versus =AUD$125; t(83) = -3.98, P < 0.0001). Fifty-six (46%) respondents had catastrophic levels of out-of-pocket spending which made them 7.5 times more likely to experience economic hardship (95% confidence interval [CI]: 1.2-46.3).
  
  
  CONCLUSIONS
  The costs associated with living with COPD make it difficult for patients and their families to afford necessary living expenses while also paying health care expenses. This is alarming within Australia where a well-funded universal health insurance system is in place. Rising co-payments for medications and private medical consultations, poorly subsidised health support (e.g. home oxygen), non-health logistics (e.g. transport) and eligibility barriers for existing social support are making chronic illness management seriously economically stressful, especially for those with low incomes, including the retired.
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia. beverley.essue@sydney.edu.au
authors.forename: Beverley
authors.initials: B
authors.lastname: Essue
authors.forename: Patrick
authors.initials: P
authors.lastname: Kelly
authors.forename: Mary
authors.initials: M
authors.lastname: Roberts
authors.forename: Stephen
authors.initials: S
authors.lastname: Leeder
authors.forename: Stephen
authors.initials: S
authors.lastname: Jan
mesh_terms: D000368:Aged; D002908:Chronic Disease; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D005382:Financing, Personal / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics* / Q000628:therapy; D014904:Western Australia