“You Have to Rob Peter to Pay Paul So Your Kid Can Breathe”

Abstract

Background: Economic analyses often focus narrowly on individual patients’ health care use, while overlooking the growing economic burden of out-of-pocket costs for health care on other family medical and household needs. Objective: The aim of this study was to explore intrafamilial trade-offs families make when paying for asthma care. Research Design: In 2018, we conducted telephone interviews with 59 commercially insured adults who had asthma and/or had a child with asthma. We analyzed data qualitatively via thematic content analysis. Participants: Our purposive sample included participants with high-deductible and no/low-deductible health plans. We recruited participants through a national asthma advocacy organization and a large nonprofit regional health plan. Measures: Our semistructured interview guide explored domains related to asthma adherence and cost burden, cost management strategies, and trade-offs. Results: Participants reported that they tried to prioritize paying for asthma care, even at the expense of their family’s overall financial well-being. When facing conflicting demands, participants described making trade-offs between asthma care and other health and nonmedical needs based on several criteria: (1) short-term needs versus longer term financial health; (2) needs of children over adults; (3) acuity of the condition; (4) effectiveness of treatment; and (5) availability of lower cost alternatives. Conclusions: Our findings suggest that cost-sharing for asthma care often has negative financial consequences for families that traditional, individually focused economic analyses are unlikely to capture. This work highlights the need for patient-centered research to evaluate the impact of health care costs at the family level, holistically measuring short-term and long-term family financial outcomes that extend beyond health care use alone.