When we talk about chronic illness, the conversation usually centers on medications, treatment plans, or physical symptoms. But for those who live with long-term health conditions, it’s often about so much more than what’s happening in the body. Chronic illness doesn’t just disrupt routines—it affects how people work, plan, connect with others, and, crucially, how they think about money and the future.
A recent study by Davis, Zhang, and Patel (2025), published in Medical Care, draws attention to this often-overlooked link between chronic illness and financial wellbeing. The study, titled Chronic Disease and Future Perceptions of Financial Control: Results from the Midlife in the United States Cohort Study focused on 3,297 of the participants who were followed for almost a decade. It found that people with a greater burden of chronic disease were far more likely to feel they didn’t have enough financial resources, had little control over their finances, and were pessimistic about what lay ahead—despite still managing to pay their bills.
Illness doesn’t just impact the body—it affects people’s confidence, their mental wellbeing, and their ability to make plans. And it often brings with it a quiet, persistent fear: What will happen if my condition gets worse and I can’t afford what I need?
The Hidden Emotional Cost of Chronic Illness
What makes this study particularly striking is that it doesn’t just focus on traditional financial markers like income loss or unpaid bills. Instead, it looks at people’s perceptions—how in control they feel over their money, how secure they feel about the future.
Participants with more chronic illnesses and those taking more medications were significantly more likely to feel financially vulnerable. Even if they weren’t in debt, they carried a sense of instability. And that feeling—of not being in control—can quietly shape how someone manages their health.
When people feel uncertain about money, it affects their decisions. They might put off appointments, space out medications to make them last longer, or stay in stressful jobs for the health insurance. It’s not always a matter of poverty—it’s about fear. The fear of things getting worse. The fear of not having enough support when it’s most needed.
This Isn’t an Isolated Finding
Living with a chronic illness changes more than just your health—it slowly begins to shape your routines, your priorities, and often, your finances too. It’s not just the obvious things like medications or appointments. It’s the time off work, the extra childcare, the travel, the emotional toll of juggling it all. The money side of illness creeps in quietly but stays loud in the background.
A report from the Kaiser Family Foundation showed that over 40% of adults in the U.S. are dealing with healthcare debt. And for a lot of people, that debt is tied directly to managing long-term conditions. Even with insurance, the out-of-pocket costs can feel never-ending.
Then there’s the stress of deciding what care to delay—or skip entirely. Even with Medicare, older adults in the U.S. are more likely to skip needed care because of cost than their peers in other high-income countries. According to the Commonwealth Fund’s 2024 survey findings, older Americans reported the highest rates of delaying treatment, tests, or follow-up care due to financial barriers—making cost a very real part of the illness experience.
And at a broader level, the OECD’s 2019 report reminds us that this isn’t just about individuals. Chronic illness has ripple effects across the economy—lower productivity, higher healthcare costs, and growing demands on social services. It’s a public issue, not just a personal one.
So Where Do We Go From Here?
If we’re serious about improving health outcomes for people with chronic illnesses, we need to see financial wellbeing as part of the picture—not an afterthought.
For policymakers, that means addressing the affordability of healthcare. Placing caps on out-of-pocket expenses, making medications more accessible, and protecting income for people living with long-term conditions are all practical steps that can ease the burden.
Healthcare providers can also play a role by acknowledging financial pressure as part of the health conversation. It’s not just about prescribing the right treatment—it’s about understanding whether patients can actually follow through. That might mean working more closely with financial counsellors, case managers, or community services who can help patients navigate insurance, medical bills, and support programs.
Private sector partners—from insurers to pharmaceutical companies to employers—also have a responsibility. Some companies are starting to offer health and financial coaching together or are trialling $0 co-pay programs for essential medications. Employers can also support staff with chronic illnesses by offering flexible work policies, job protection, and long-term disability options that offer real security.
A great example of this kind of partnership is the initiative by CVS Health, which brings together medication management, nutrition support, and financial education in community-based chronic care hubs. These projects show what’s possible when public and private organisations collaborate around the real needs of patients.
But beyond systems and services, we also need to listen more carefully to people living with these conditions. Their insights should guide how we design health policies, insurance programs, and care pathways. They are not just patients—they are experts in managing day-to-day survival.
Financial Insecurity Is a Health Risk
This study puts evidence behind something that many people already know in their bones: that chronic illness slowly wears down not just your health, but your sense of control and your trust in the future. Even when things look manageable on paper, the emotional toll can be exhausting.
And we need to say this clearly—financial insecurity is a health risk. Not just because of what it prevents people from doing, but because of what it does to their sense of dignity and hope.
We often encourage people to “take control of their health.” But that’s a big ask when the rest of life feels completely out of control. That’s why it’s so important to build systems that support both physical and financial well-being. Because it’s not a luxury. It’s a public health necessity.
Closing Reflections
Health doesn’t exist in a vacuum. It’s shaped by housing, employment, community, and yes—by money. The longer we pretend otherwise, the more we push people to manage invisible struggles on their own.
The research by Davis and colleagues in Medical Care is a timely reminder that there’s so much more to illness than symptoms and test results. It’s a lived experience—and that experience includes fear, choices, trade-offs, and resilience.
If we want to build a health system that truly supports people, we need to listen to what the data—and the people living it—are telling us. Because people don’t just want to survive their illnesses. They want to live with dignity, with confidence, and with the ability to plan for something better.
