Persistence of Financial Burdens and Barriers among Adults with Functional Limitations and Chronic Conditions

Background: Previous research has shown that people with multiple chronic conditions have higher-than-average health expenditures and health-related financial burdens.  A recent study has shown that functional limitations lead to high health-related financial burdens not only due to higher health care expenditures but also by reducing a person’s ability to work and pay for care.

While persistence of health-related financial burdens among those with chronic conditions has been examined, persistence of burdens among the critical subpopulation with both functional limitations and chronic conditions has not been examined.

Objective: To examine persistence of financial burdens and barriers to care among nonelderly adults living in families with an adult who has functional limitations and chronic conditions. 

Methods: High financial burden is defined as medical spending exceeding 10 percent of family income.  Financial barriers are defined as delaying care/being unable to get care for financial reasons, and reporting that delaying care/going without was a big problem.  We examine the prevalence of having high burdens and financial barriers for two consecutive years.  Data are from 6 panels of the Medical Expenditure Panel Survey from 2008 to 2013.  Functional limitations are defined as receiving assistance with Activities of Daily Living (ADL) and/or receiving assistance with Instrumental Activities of Daily Living (IADL).

Results: Preliminary results show that functional limitations are associated with increased prevalence of persistent financial burdens: 18.4% of adults living in families with at least one adult with functional limitations had high burdens for two consecutive years, compared to 9.1% among adults living in families with no adult with functional limitations.  Preliminary results also show that multiple chronic conditions are associated with increased prevalence of persistent financial burdens: 18.2% adults living in families with at least one adult with three or more chronic conditions had high burdens for two consecutive years, compared to 5.9% among adults living in families in which no adult had any chronic conditions.  More significantly, we find that even when we focus on those with three or more chronic conditions, those living in families with an adult with functional limitations are more likely to have persistent financial burdens: 22.5% adults living in families with one adult with functional limitations and three or more chronic conditions had high burdens for two consecutive years, compared to 14.1% among adults living in families with one adult with three or more chronic conditions but no functional limitations. We also examine whether adults with functional limitations and multiple chronic conditions have persistent financial barriers to care.

Conclusions: Functional limitations and chronic conditions are associated with increased persistence of health-related burdens.