Cost Concerns Delay Heart Attack Care
Uninsured, Underinsured Patients Seek Treatment Later, Study Finds
WebMD News Archive
April 13, 2010 -- Patients without health insurance and even insured
patients worried about paying for medical care are more likely to delay seeking
treatment during a heart attack, new research confirms.
It is well recognized that uninsured and underinsured people access
preventive medical care and receive treatment for chronic conditions like
diabetes and asthma less often than people who are fully insured. But this
study is among the first to suggest that cost concerns affect decisions about
potentially lifesaving emergency medical care.
Nearly half of uninsured heart attack patients surveyed and 45% of people
who considered themselves underinsured delayed seeking medical treatment for
more than six hours after symptoms began, compared to 39% of patients without
The study appears in today’s issue of the Journal of the American Medical
“We have good lifesaving treatments that can prevent heart muscle damage
during heart attacks,” study co-author Paul S. Chan, MD, tells WebMD. “But
after about six hours the benefits of many of these therapies are limited, and
beyond 12 hours they are unlikely to be of any benefit at all.”
70 Million Lack Adequate Coverage
About 45 million Americans have no health insurance, and 25 million have
insurance with prohibitively high medical co-pays and deductibles, according to
a recent analysis.
In an effort to determine how insurance status affects decisions about
treatment during heart attacks, Chan and colleagues analyzed data from
interviews with 3,721 patients treated at 24 U.S. hospitals between April 2005
and December 2008.
All the patients were enrolled in a heart attack registry and all were asked
about their insurance status and financial concerns regarding their medical
Nearly 62% of the patients were insured with few financial concerns, while
20% and 18%, respectively, were uninsured or had financial concerns about
Among insured patients who had financial concerns, 83% reported having gone
without medical care because of cost, 56% said financial concerns kept them
from taking prescribed medications, and 13% said they had a hard time obtaining
medical services because of cost.
About a third of the patients (1,273) reported seeking medical treatment
within two hours of noticing symptoms of a heart attack, while 42% (1,567)
reported waiting more than six hours after symptoms began.
After adjusting for other factors that could contribute to treatment delays,
uninsured and underinsured patients were 38% and 21%, respectively, more likely
to delay treatment for more than six hours than fully insured patients, Chan
More than half of patients who considered themselves underinsured had
fee-for-service medical plans or were covered by HMOs.
“This makes it clear that having insurance does not mean that care is
affordable,” Chan says.