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Medical Cost Burdens Among Nonelderly Adults With Asthma
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Medical Cost Burdens Among Nonelderly Adults With Asthma

Emily Carrier, MD, and Peter Cunningham, PhD
People with asthma face substantial out-of-pocket costs-even when they take medications to manage their illness. However, many choose to continue treatment despite these costs.
Healthcare providers and policy makers encourage patients to pursue self-management of their chronic illnesses, including adherence to recommended medications. Our results suggest that respondents who used medications were more likely to be in families for whom medical costs posed a high financial burden, although this burden did not appear to influence their likelihood of continuing to use medications. That patients are willing to incur high out-of-pocket costs (relative to their income) does not necessarily mean that such costs are affordable, as they may cut back in other areas or incur substantial debt. Prior research has shown that a large percentage of people with high out-of-pocket costs have problems paying their medical bills, and as a result they often cut back on other necessities, put off major purchases, withdraw money from savings, or incur debt.21

In this sense, asthma patients may differ from patients with other chronic diseases, such as hypertension or hyperlipidemia, who do not necessarily face immediate consequences of failing to adhere to treatment. By contrast, asthma patients who do not adhere to treatment face the very real and short-term threat of an asthma attack or other exacerbations, and may therefore place a high priority on maintaining their treatment. These patients might benefit from value-based strategies in which medications recommended for the self-management of chronic illness are offered through extremely generous cost-sharing arrangements. But because cost-sharing interventions are often judged by their effects on healthcare spending and utilization in the targeted clinical areas rather than by their broader health effects or their effects on other areas of a patient’s life, patients’ apparent willingness to continue using medication even in the face of high financial burden may understate the effects of such interventions.

Author Affiliations: Seamless Care Models Group, CMS Innovation Center, CMS, Baltimore, MD (EC); and Department of Healthcare Policy and Research, Virginia Commonwealth University, Richmond, VA (PC).

Source of Funding: This study was supported by the Commonwealth Fund.

Author Disclosures: Dr Carrier contributed to this research prior to her employment at CMS. Views expressed are the authors' own and do not necessarily represent the opinions or policies of CMS or HHS. Drs Carrier and Cunningham report no conflicts of interest.

Authorship Information: Concept and design (EC, PC); acquisition of data (EC, PC); analysis and interpretation of data (EC, PC); drafting of the manuscript (EC, PC); critical revision of the manuscript for important intellectual content (EC, PC); statistical revision (EC, PC); obtaining funding (PC); administrative, technical, or logistic support (EC, PC); and supervision (PC).

Address correspondence to: Emily Carrier, MD, Seamless Care Models Group, CMS Innovation Center, Centers for Medicare & Medicaid Services, 7500 Security Blvd, WB-15-64, Baltimore, MD 21244. E-mail:

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