Medical Bills May Lead to Financial Hardship for Select CV Patients

Medical bills often lead to financial hardship for nonelderly atherosclerotic cardiovascular disease (ASCVD) patients and their families, a survey suggested.

About 45% of the ASCVD patients reported having financial challenges because of medical bills, with nearly half of those saying they couldn't pay their medical bills at all, reported Khurram Nasir, MD, MPH, MSC, of Yale New Haven Health in Connecticut, and colleagues in the Journal of the American College of Cardiology.

An estimated 55% of ASCVD patients had no financial hardship from medical bills; 26% reported financial hardship from medical bills but still being able to pay, the investigators found.

Moreover, individuals reporting inability to pay medical bills also had high rates of medication nonadherence for cost reasons (49%), food insecurity (53%), and general financial distress (71%). Among those unable to pay bills, 19% faced all three.

Nasir and colleagues analyzed data on 6,160 ASCVD patients ages 18 to 64 years drawn from the National Health Interview Survey (NHIS) in 2013-2017. The NHIS asked respondents about financial hardship due to medical bills, food insecurity, cost-related medication nonadherence, and general financial security.

Many people with ASCVD are still at risk for financial hardship despite having insurance because of remaining out-of-pocket costs -- premiums, copays, coinsurance, deductibles -- often remain considerable. This is a topic of widespread public concern, but the existing literature on patients with ASCVD lacks estimates of the financial hardships from insurance and economic disparities as well as medical bills, Nasir and colleagues noted.

"The current health care system fails to protect a significant proportion of nonelderly ASCVD patients from financial hardship and its dire consequences," they wrote, adding that an evaluation of tradeoffs that people face for cost reasons may inform policy initiatives to lessen these risks, the researchers highlighted.

Physicians need to seek policy-level solutions, such as expanding coverage of uninsured or underinsured patients to limit their out-of-pocket costs, Nasir told MedPage Today, but they can also help patients more directly.

"First, we need to play our role in taking charge in having these ... conversations with our patients," he said. "Second, we need to systematically screen patients at risk for financial hardship and tailor management to help find alternatives for our patients which may cost less, as well as avoid procedures and interventions with marginal benefit."

And, he said, "we need to play an active role in working with our local health-system and community financial assistance support programs to provide financial assistance to those in need."

These findings highlight the current crisis and irony in the American healthcare system, said Karen Joynt Maddox, MD, MPH, of Washington University School of Medicine in St. Louis, who was not involved in the study.

Clinicians have access to lifesaving technologies for managing cardiovascular disease in their patients, but using these technologies can be financially demanding, she told MedPage Today. "Our patients desperately need access to affordable insurance coverage to ensure that an unexpected cardiovascular event doesn't put them into financial ruin. As a clinical community, I see it as our responsibility to continue to advocate for health reform to address these problems."

Nasir noted some limitations of the investigation: "We were not able to calculate the actual amounts of money among financial hardship groups due to this information not being within our reach, and we were not able to completely determine if these hardships were directly related to ASCVD – although we hypothesize it plays a major role."

Future efforts "aimed at improving medication adherence may look to focus on cost-related barriers and limiting financial toxicity from regular medical care," Nasir and colleagues wrote.

Nasir reported no financial disclosures.


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