Table 3.

Major domains identified in focus groups with women with asthma about what encompasses perceptions financial burden.

Domain	Descriptors	Example
High out-of-pocket expenses	Medicines (especially related to asthma), environmental control and urgent care use contribute to high out-of-pocket expenses	“…And when you’re an asthmatic, you’re often times prescribed Advair, you have to use it monthly, 30 days. So, that’s 300-plus dollars a month…in my experience, as a sole practitioner, I had an individual insurance plan that only covered $2500 worth of, um, pharmaceuticals. Within the first three months of having that, I used up the $2500 because I had to have four inhalers, with the average cost being about $250. So, in one year, I spent on medication for asthma, out of pocket, $5720. Out of pocket, to breathe.”
Lost wages	Asthma exacerbations require recovery time that use up paid sick days from work very quickly and contribute to difficulties in maintaining stable employment	“Yeah, it cuts into that time. When I have an asthma attack, I’m off from work for two or three days for sure. It ain’t no go to the hospital – and then go to work tomorrow. That don’t happen. It’s a – you know, you’re gonna be off for a couple of days.”
Distance to health-related resources	Affordable urgent care facilities and administrative offices to ensure government-sponsored health insurance are often far and the time and gas required are described as expensive	So, it’s hard for me right now to have to deal with social services, case workers and paperwork. It’s so expensive, and I have to drive all the way to [town in sample region] and drive back. It’s just hard, you know, dealing with all of that.
Managing health insurance	Comprehensiveness of coverage, uncertainty with maintaining insurance coverage in a volatile economic climate and false bills contribute to access difficulties with the resources people need to manage their asthma and health	“they’ll still try to run out and bill you. Then I’m like, “where did this come from? I got Medicaid. You know?” So, you still have to deal and keep up with your stuff. I still have a lot of bills, even though I have Medicaid, I still have a lot of bills. I call them and try to straighten it out, but then they get, they don’t even—And then that’s time, on the phone all day – and they all, “hold on. I got to get you to such-and-such.” Then you talk to such-and-such. Such-and-such can’t help you. You – and next thing you know, you on the phone back and forth for two hours about a medication or a bill that you shouldn’t have even been billed for.”