Yarning Up About Out of Pocket Healthcare Expenditure in Burns with Aboriginal Families

Ms Courtney Ryder1,2, Dr Tamara Mackean1,2, Dr  Kate Hunter1, Ms Julieann Coombes1,3, Professor Andrew Holland4, Professor Rebecca  Ivers1,2,5

1The George Institute for Global Health, Newtown, Australia, 2Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia, 3The University of Technology Sydney, Broadway, Australia, 4School of Medicine, The University of Sydney, Westmead, Australia, 5School of Public Health and Community Medicine, UNSW, Sydney, Australia



Burn injuries are expensive to treat, and are a significant cost for families through out-of-pocket healthcare expenditure (OOPHE). OOPHE are additional health related costs not covered by universal taxpayer funded health insurance, and can include medication, transport, wage or educational loss. This study sought to understand the impact of OOPHE on Aboriginal families affected by burn injuries.


Families of Aboriginal children ≤ 16 years who had sustained a severe burn injury from 5 hospital sites were invited to participate. Severe burn injury was defined as ≥1 night hospital stay with follow-up care and TBSA%≥10. Yarning sessions with participants explored OOPHE for burns care that families may have encountered during their child’s treatment. Yarning is an Indigenous research method, encompassing a conversational technique to gather information from participants. Indigenous research methods were applied to identify main themes from transcripts; data were organised using NViVO (Version 12).


Five yarning sessions were undertaken. Ten themes were identified, including costs (i.e. transport, pharmacy), loss (i.e. financial, employment capacity), sibling impacts (i.e. psychological), family support (i.e. financial) and financial stress. Inequities were present, such as lack of support, where participants were ineligible in accessing government support initiatives (i.e. carer pension). The need to cover OOPHE significantly impacted families, from restricting social interactions to paying household utilities.


This study has provided new understandings of OOPHE from the perspective of Aboriginal families. These results will inform the development of the first OOPHE tool to assess cost impacts of burn injury on Aboriginal families.


Courtney Ryder is a PhD student in the Injury Division at The George Institute. Her studies are part of the Coolamon study, understanding burn injuries in Aboriginal and Torres Strait Islander children: treatment, access to services and outcomes. For which she has a NHMRC postgraduate scholarship to investigate the trajectory of recovery, quality of life, parental resilience and economic impacts of Aboriginal and Torres Strait Islander families whose children are recovering from a burns injury. She is also a CI for on the NHMRC funded study, preventing falls in older Aboriginal people: the Ironbark trial. Ryder is seen as an emerging research leader in Aboriginal injury and rehabilitation, with a keen interest on equitable health outcomes for communities.

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