Cost: A Deadly Barrier to Health Care

Heart Attacks Worse for People Who Can't Pay

From the WebMD Archives

March 13, 2007 -- Short on cash? Don't have a heart attack.

That is very cold advice. Nobody wants to have a heart attack. But if you do have one -- and if your financial situation means you sometimes have to cut back on health care -- you're less likely to recover as fully as more fortunate Americans.

The finding comes from a study of 2,498 heart attack patients treated in medical centers across the U.S. Nearly one in five patients said they sometimes avoided getting health care because of cost. And nearly 13% said that cost kept them from taking the drugs they needed.

"Financial barriers are potent risk factors for adverse outcomes after heart attacks," study leader Harlan M. Krumholz, MD, Yale University professor of medicine, said at a news conference. "Financial barriers are associated with greater symptoms, worse quality of life, and a higher risk of being readmitted to hospital after a heart attack."

It's not simply a matter of health insurance. More than two-thirds of heart attack patients who can't afford proper health care have health insurance, the study showed.

Can't Pay? Back to the Hospital

Even when they got exactly the same hospital care immediately after their heart attack, patients who later encountered financial barriers did worse.

A year after their heart attacks:

  • Patients with financial barriers to health care services were 30% more likely to need a second hospital visit for heart symptoms than were patients without financial barriers.
  • Patients with financial barriers to prescription drugs were 70% more likely to need a second hospital visit for heart symptoms.
  • Patients with financial barriers to prescription drugs were 55% more likely to suffer angina-- chest pain due to reduced blood flow to the heart muscle.
  • Quality of life was significantly worse for patients with financial barriers to health care and medication.

"Is it OK for us to live in a country where, when you leave the hospital, your financial circumstances dictate your quality of life?" Krumholz said. "Are we, as a country, going to find that repugnant?"

The findings appear in the March 14 issue of The Journal of the American Medical Association. The issue is dedicated to articles addressing U.S. access to health care. The news conference at which Krumholz spoke was organized by the journal's editors.

Continued

Ill Uninsured in 'Death Spiral'

The Krumholz study showed that health insurance doesn't guarantee proper health care. But when you suffer a health shock, it's a lot better than no health insurance, finds Jack Hadley, PhD, an economist at the nonprofit Urban Institute in Washington, D.C.

Hadley analyzed data from the Medical Expenditure Panel Surveys. The surveys consist of in-person interviews with a national sample of nonelderly Americans, spaced four or five months apart. Nearly 16,000 U.S. residents answered questions about unintentional injuries and nearly 8,000 provided information on the onset of chronic illnesses.

Injuries included any kind of athletic or nonathletic accident -- a sprained ankle, for example, or injuries from a car crash. Chronic illnesses were new diagnoses of chronic conditions -- heart attacks, cancer, diabetes, and so on.

After one of these "health shocks," compared with people with health insurance, people without health insurance were:

  • 53% less likely to get medical care after an accident and 55% less likely to get medical care after a newly diagnosed chronic condition.
  • 2.6 times less likely to get recommended follow-up care after an accident and 65% less likely to get recommended follow-up care after diagnosis of a new chronic condition.
  • 29% less likely to get prescription medicines.

An average 3.5 months after a health shock, those without insurance were 14% more likely to say they were much worse off after an injury and 26% more likely to say they were much worse off after diagnosis of a chronic illness.

Seven months after a health shock, uninsured people were still more likely to report much worse health.

"The uninsured are significantly less likely to say they are not fully recovered -- and not because they are still in treatment," Hadley said at the news conference. "They have ended their treatment process and still are not recovered."

For those with a chronic illness, this lack of treatment may be the beginning of the end.

"This can lead to a death spiral -- a literal death spiral," Hadley said. "If you are not treated for a chronic illness, your risk of death increases over time."

Continued

Cost of Insurance vs. Cost of Uninsurance

Hadley said his study dispels the myth that people without health insurance somehow find a way to get medical care.

The Journal of the American Medical Association Editor-in-Chief Catherine D. DeAngelis, MD, MPH, told the news conference that the U.S. spends 2 trillion dollars -- that's $2,000,000,000,000 -- on health care.

Yet 47 million Americans -- including 9 million children -- lack health insurance. And an estimated 16 million more Americans are underinsured.

"And how many millions with insurance still don't have access to health care?" she asked.

Hadley said the cost of providing health insurance to uninsured Americans is far less than the cost of having so many Americans uninsured.

"There are substantial costs to not covering the uninsured," he said. "One is the loss of health to the uninsured people. Second is their lost productivity -- that, in turn, has spillover to the rest of society. And if we don't pay for their insurance, we pay for the increased costs [to the health care system]."

WebMD Health News Reviewed by Louise Chang, MD on March 13, 2007

Sources

SOURCES: Rahimi, A.R. The Journal of the American Medical Association, March 14, 2007; vol 297: pp 1063-1072. Hadley, J. The Journal of the American Medical Association, March 14, 2007; vol 297: pp 1073-1084. The Journal of the American Medical Association news conference with: Harlan M. Krumholz, MD, professor of medicine, epidemiology, and public health, Yale University School of Medicine, New Haven, Conn.; Jack Hadley, PhD, The Urban Institute, Washington, D.C.; Catherine D. DeAngelis, MD, MPH, editor-in-chief, The Journal of the American Medical Association.

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