High costs may be keeping working-age heart patients from seeking care
A new study of U.S. healthcare data found that more than 1 in 3 working-age adults with cardiovascular disease are spending more than 10% of their income on healthcare expenses. In addition, 1 in 10 are facing catastrophic healthcare expenditures.
The data was published JACC, the flagship journal of the American College of Cardiology.[1]
According to the study's authors, their analysis calls attention to the impact of the rapidly rising costs of cardiac care and the need for policy changes reducing financial barriers.
"Given the confluence of rising costs and worsening cardiovascular health among working-age adults, reducing financial barriers to care must be central to national efforts to improve cardiovascular outcomes in this population," wrote lead author Smaraki Dash, MD, MPH, with the Richard A. and Susan F. Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center in Boston, and colleagues.
Dash et al. said policies needs to be changed to ensure patients can afford consistent access to preventive, diagnostic and therapeutic cardiovascular services and that they do not forego care. Despite substantial national spending, cardiovascular risk factor control and outcomes have worsened in adults ages 25-64 since 2010. Financial barriers are likely driving these trends, especially among privately insured adults, who face higher out-of-pocket costs than those with public insurance.
Researchers looked at data from the Medical Expenditure Panel Survey between 2007-2022 to identify 4,036 patients in this age group with private health insurance coverage and cardiovascular disease or cardiovascular risk factors. These included conditions such as coronary artery disease, angina pectoris, myocardial infarction, peripheral artery disease, stroke, and/or related risk factors like hypertension, diabetes, hyperlipidemia and transient ischemic attacks.
Healthcare expenditures were calculated as the sum of patient payments to insurance premiums and out-of-pocket expenses on medical services and prescription drugs. Researchers then examined changes in financial burden, which they defined as healthcare spending exceeding 10% of income, and catastrophic financial burden, defined as spending exceeding 40%. Regression models were used to evaluate trends over time. The dollar amounts were calculated for inflation to reflect 2022 U.S. dollars.
Between 2007-2022, total inflation-adjusted healthcare expenditures for these patients increased from $4,813 to $5,304. This rise was largely driven by an increase in insurance premiums ($3,389 to $3,919). Out-of pocket costs remained mostly unchanged between $1,384 and $1,558.
The proportion of individuals experiencing healthcare-related financial burden remained about the same over the course of the study, landing between 34.6% to 34.2%. There also was a minor decline in catastrophic financial burden, from 10.8% to 9.2%.
The findings showed that while insurance premiums increased, out-of pocket spending remained stable. Researchers theorize these patterns could reflect insurers’ increasing reliance on premium growth rather than higher point-of-care cost sharing, or its could be due to patients not using their healthcare coverage in and effort to cut their own costs in response to higher premiums.
"In the context of worsening cardiometabolic health among younger working-age adults, rising premiums represent an underrecognized but critical barrier to accessing and receiving guideline-directed cardiovascular care," the authors concluded.
They suggested possible policy strategies to help compensate for these effects, including federal premium regulation, enhanced income-based subsidies and moving toward value-based insurance plans. The authors also suggested expanding drug price negotiations due to brand-name therapies being a key driver of spending in this study.
The authors said limitations of the study include the use of self-reported survey data and not fully knowing illness severity, which could have impacted care utilization and expenditures.
This research was supported by funding from the National Heart, Lung and Blood Institute and a grant from the American Heart Association Established Investigator Award.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]