Financial well-being and health

Reginald Tucker-Seeley

October 6, 2014 — A new study by HSPH’s Reginald Tucker-Seeley and colleagues found that the depletion of a family’s financial resources was a significant predictor of intensive end-of-life care. In particular, their study found that families facing financial hardship were three times more likely than other families to opt for aggressive end-of-life care for a seriously ill loved one, even after accounting for patient preferences. In much of his research, Tucker-Seeley, explores the concept of financial well-being and its effects on health.

Can you discuss the difficulties some financially strapped families face when dealing with end-of-life care for a loved one?

Our study found that families facing financial hardship are more likely than other families to choose aggressive, hospital-based care for their loved ones. It’s possible they’re making this choice because such care is covered by insurance, compared with less intensive home-based treatments that families might think are less likely to be covered. Medical care for a loved one with a serious illness—even with insurance—can impose a substantial financial burden on families. So some of these families may wind up not only having to endure their loved one going through intensive care at the end of life that may be painful, they may then have to confront the exhaustion of their financial resources. In our study, we suggest that interventions that specifically target family financial hardship during end-of-life care—and that provide financial incentives for families to choose home or hospice care instead—may help improve such situations.

How hopeful are you that interventions targeting family financial hardship during end-of-life care—which, as you point out in your study, would require much coordination—will become more the norm?

In the paper we note that this really is going to take a multidisciplinary approach. The physician, the psycho-oncology staff, the social workers—all will have to work with families to help them think about how best to manage their loved one’s illness and the financial implications of their decisions. Perhaps it would also help to have “financial navigators” to help families better understand the direct and indirect costs of managing a terminal illness. We know from research in social epidemiology that people are better able to navigate life’s challenges if they have someone to help them. It will be a struggle to get multidisciplinary teams to the table to address this issue, but I do think it’s possible.

A big focus of your work involves clearly defining what “financial well-being” actually means. Why is that important?

We usually measure socioeconomic status, or SES, with measures such as education and income. In the health disparities literature, sometimes the focus is primarily on the economic resources that people have, and sometimes it’s on how people feel about those resources. I realized that there wasn’t a concept that pulled these two things together. I thought the concept of “financial well-being” was a good way to do that. I contend that financial well-being is not just about the financial resources that you have, but how you feel about those resources. Does your level of financial resources make you feel stressed? Do you feel like you have enough? And a big issue in the current economic climate: Are your financial resources stable and consistent?  One of the things we’ve found in our work is that, even among people who have a very low level of income, there is variability around financial hardship. You might expect that everyone in this situation would say they experience financial hardship—but, surprisingly, not everyone does. Additionally, for those that do report financial hardship they also report lower levels of self-rated health.

In the future, I would really like to see the measures we’re developing around financial well-being be used across multiple studies—at the large population level, as well as in smaller community-based studies to expand the measurement of socioeconomic circumstances. I believe that measures of financial well-being can really help explain how our socioeconomic status is really lived, and help us better understand how that experience is related to our health decision-making, our health behavior, and, ultimately, to our health.

Karen Feldscher