Strategies for managing the costs of chronic illness in the context of limited financial resources: a qualitative study in Dominican persons with arthritis.

OBJECTIVE: Persons in low- and middle-income countries often have insufficient resources to pay for treatments prescribed for their medical conditions. We aimed to determine, using qualitative methods, how people with arthritis in the Dominican Republic manage the costs of chronic illnesses.

METHODS: We conducted individual interviews with 17 Dominican adults with advanced arthritis undergoing total knee replacement (TKR) or total hip replacement (THR) at a hospital in Santo Domingo, Dominican Republic. Interviewers followed a moderator's guide with questions pertaining to the financial demands of arthritis and strategies participants used to pay for treatments. Interviews were audio-recorded, transcribed verbatim, and translated into English. We used thematic analysis to identify salient themes.

RESULTS: The thematic analysis suggested that health system factors, such as the extent of reimbursement for medications available in the public healthcare system, along with personal factors, such as disposable income, shaped the individual's experience of managing chronic illness. These systemic and personal factors contributed to a sizeable gap between the cost of care and the amount most participants were able to pay. Participants managed this resource gap using a spectrum of strategies ranging from acceptance or "making do with less," to resourcefulness or "finding more." Participants were aided by strong community bonds and religiously-oriented resilience.

CONCLUSION: This qualitative study illuminates the range of strategies Dominicans with limited resources use to obtain healthcare and manage chronic illness. The findings raise hypotheses that warrant further study and could help guide provider-patient conversations regarding treatment adherence. This article is protected by copyright. All rights reserved.