A new study from RCSI University of Medicine and Health Sciences has highlighted the difficult healthcare choices faced by people with chronic conditions when experiencing financial constraints.

Published in BMC Primary Care, the research shows that Irish people with chronic conditions are forced to sacrifice aspects of their healthcare or reduce basic living expenses to afford their health costs.

The study surveyed 962 adults in Ireland aged 40 and over with chronic health conditions. Many participants struggled financially with over a third (34.5%) saying they had avoided healthcare appointments or buying medicine in the past year due to cost concerns. This issue was even more pronounced for those with multiple chronic conditions. To afford their healthcare, almost half (46%) of participants had cut down on general expenses, 30% accessed savings and 22% reduced food spending. When deciding what informed the areas of healthcare they prioritised, respondents valued staying alive, controlling symptoms, and maintaining their independence.

The survey was undertaken in 2021 and 2022. Since then, several government measures have been introduced including a reduction in the monthly limit for prescription costs and the removal of public in-patient and day service fees, however, the cost of living has significantly increased.

Dr James Larkin, lead author of the study and Senior Postdoctoral Fellow at RCSI Department of General Practice, explained: “Our research highlights the difficult decisions people with chronic conditions are forced to make when facing financial strain. Many people are sacrificing important aspects of care, which may have significant long-term health implications.

“Despite the measures introduced by the government, financial issues remain a key factor in healthcare decisions, meaning that people facing economic hardship today are likely to make similar choices to those we spoke to.”

In addition to sharing real-world experiences, participants engaged in a decision-making exercise exploring how they would adjust their healthcare spending if their monthly budget were cut by 25%. Hospital visits and specialist care were most likely to be cut by participants, while medication spending was reduced the least, reflecting the reported real-life choices. Those with multiple chronic conditions tended to focus their spending on one condition over others rather than reducing expenditure across all conditions equally.

The study’s findings underscore the need for healthcare policies that consider the different ways individuals with chronic conditions respond to financial constraints. Dr Larkin added: “Policy interventions, such as reducing payment barriers or providing targeted financial support, could help prevent cost-related non-adherence and its negative health impacts. Also, healthcare professionals should consider the financial constraints their patients may face and openly discuss healthcare costs and coverage options.”

The research calls for healthcare providers and policymakers to take greater account of financial challenges in clinical care and healthcare planning.

The research was supported by funding from the Health Research Board (HRB) and carried out in collaboration with Professor Susan M. Smith at Trinity College Dublin, Dr Louise Foley at the University of Limerick, Dr Shane Timmons at The Economic and Social Research Institute (ESRI), Dr Patricia Harrington at the Health Information and Quality Authority (HIQA), Tony Foley and Dr Barbara Clyne at RCSI University of Medicine and Health Sciences. The full study titled ‘How do People with Multimorbidity Prioritise Healthcare when Faced with Tighter Financial Constraints? A National Survey with a Choice Experiment Component.’ is available in BMC Primary Care.