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Financial burden evident regardless of insurance status in CVD
High financial burden was experienced by 1 in 4 low-income families with a member who had atherosclerotic CVD, including those with insurance coverage, according to a study published in JAMA Cardiology.
The researchers also reported that 1 in 10 low-income families experienced catastrophic financial burden caused by out-of-pocket health care expenses.
“There are many people who are not only suffering from the disruption, pain and suffering associated with an acute illness or chronic condition, but also dealing with the financial toxicity of the associated health care costs to them and their families,” Harlan M. Krumholz, MD, SM, professor of medicine, investigative medicine and health policy, co-director of the Robert Wood Johnson Foundation Clinical Scholars Program at Yale University and director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital, said in a press release. “We’re doing this research to put some numbers to this issue so that it can’t be ignored. These numbers will influence the policy debates about health care, for when people say, ‘We’re doing well enough,’ or ‘Things have gotten better,’ we can show with these numbers that, no, we’re not nearly where we need to be.”
MEPS data
Rohan Khera, MD, fellow in the clinician-investigator pathway of the division of cardiology at University of Texas Southwestern Medical Center in Dallas, and colleagues analyzed data from 22,521 patients with atherosclerotic CVD from the Medical Expenditure Panel Survey (MEPS) from 2006 to 2015. Interviews were conducted with families to collect information on health status, demographics, financial characteristics, financial support for health care needs and health care access. Families with one or more members with atherosclerotic CVD were included.
Low income was defined as an annual income less than 200% of the federal poverty limit, whereas mid/high income included families that exceeded 200% of the federal poverty limit.
The patients featured represented 20,600 families sampled in MEPS and corresponded with an annual estimated 9.9% of adults (mean age, 66 years; 47% women) and 15% of families in the U.S.
Of these families, 39% were low income with a mean annual family income of $57,143 (95% CI, 55,377-58,909). The mean out-of-pocket expense was $4,415.
Financial burden
Although financial burden related to health expenses decreased throughout the study, compared with mid- to high-income families, low-income families were more likely to have high financial burden (21.4% vs. 7.6%; OR = 3.31; 95% CI, 2.55-4.31) and catastrophic financial burden (9.8% vs. 1.2%; OR = 9.35; 95% CI, 5.39-16.2). This was representative of an estimated 2 million low-income families in the U.S.
In 2014 and 2015, 21.8% had high financial burden and 9.8% experienced catastrophic out-of-pocket health care expenses among families who were insured.
“Our findings highlight that high insurance premiums and out-of-pocket spending on prescription medications represent potential targets for health policy interventions with the goal of reducing financial hardship from health care costs,” Khera and colleagues wrote. “Until high health care expenses are addressed, use of health care services will likely impede the financial stability and upward mobility of low-income families. Moreover, patients and their families will continue to be at risk for negative health consequences from major financial hardship.” – by Darlene Dobkowski
Disclosures: Krumholz reports he is a recipient of research agreements from Johnson & Johnson (Janssen) and Medtronic, serves as a chair of the cardiac scientific advisory board for UnitedHealth, founder of Hugo, a participant of the Watson Health Life Sciences Board for IBM, a member of the physician advisory board for Aetna and has received a grant from Medtronic. The other authors report no relevant financial disclosures.