The burden of financial costs of healthcare for people with multimorbidity

Multimorbidity (two or more chronic conditions) is associated with increased out-of-pocket healthcare expenditure; however, there is insufficient research on multimorbidity’s financial impact on individuals. This thesis researched the financial impact of living with multimorbidity: the lived experience of this, levels of out-of-pocket healthcare spending, and how people with multimorbidity prioritise healthcare when facing affordability challenges. The thesis researched community-dwelling adults with multimorbidity. A systematic review of qualitative research on multimorbidity and financial burden was conducted by searching databases and grey literature. A cross-sectional study examined the impact of multimorbidity on out-of-pocket healthcare expenditure using a generalised linear model. A choice experiment was conducted with an online sample, examining how people with multimorbidity prioritise healthcare when faced with affordability challenges. The systematic review of qualitative research thematically synthesised 46 studies. Four themes were generated: the high costs people with multimorbidity experience, coping strategies to manage costs, negative effects of these areas on well-being, and how health insurance and government supports determine cost manageability. The cross-sectional study examining multimorbidity’s impact on out-of-pocket healthcare expenditure included 5,898 participants. Among participants who had any out-of-pocket healthcare expenditure, individuals with multimorbidity spent more on average annually (€806.8 for two conditions, €885.8 for three or more conditions), than individuals with no conditions (€580.3). A strong positive association was found between number of conditions and out-of-pocket healthcare expenditure. The choice experiment included 962 participants and found they were most likely to report prioritising their medicines and least likely to prioritise ‘other healthcare (hospital visits, specialist doctors, etc.)’. Also, when facing financial constraints, participants with multimorbidity reported prioritising one condition. This thesis shows the burden healthcare costs place on people with multimorbidity. This financial burden can be explored and addressed using cost-of-care conversations and can be mitigated by targeted healthcare entitlements.