Beyond co-pays and out-of-pocket costs: perceptions of health-related financial burden in managing asthma among African American women

Abstract

Objective: The purpose of this study was to define perceptions of health-related financial burden based on the views of individuals who report these perceptions through qualitative approaches. Methods: Four focus groups were conducted in Southeast Michigan with 26 African American women with asthma, recruited based on maximum variation sampling procedures. A semi-structured interview was employed by facilitators. Coded transcripts were analyzed for themes regarding dimensions of the meaning of financial burden. Results: Major domains of financial burden identified included (1) high out-of-pocket expenses; (2) lost wages from exacerbations, inability to maintain a stable job and stress from making decisions about taking a sick day or coming to work; (3) transport costs; (4) both costs and stress of managing insurance eligibility and correcting erroneous bills. Conclusion: Greater awareness of factors that add to perceptions of financial burden might better equip researchers to develop interventions to help care teams manage such concerns with their patients.

• Asthma
• health insurance
• illness and disease experiences
• risk factors

Acknowledgements

The authors would like to thank Katherine Faiver, Emily Salvette, Meagan Shallcross and Edward Tsai for their assistance with preparing the focus groups; Peter Song, Melissa Valerio, and Jack Wheeler for feedback on the work presented here; and Lauren Nichols, Zoe Tullis and Marianna Manikas for their assistance preparing the manuscript. The authors also thank the Women of Color and Asthma Control Study Team for providing access to participants and expert feedback on the discussion guide. This work is dedicated to the loving memory of Dr. Noreen M. Clark, Director of the Center for Managing Chronic Disease at the University of Michigan, School of Public Health.