Cost: A Deadly Barrier to Health Care
Heart Attacks Worse for People Who Can't Pay
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
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
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
- 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
The findings appear in the March 14 issue of TheJournal 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.
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.