In the Journals

Financial hardship from medical bills common in ASCVD

Khurram Nasir
Khurram Nasir

More than 45% of patients with atherosclerotic CVD were members of families with financial hardship related to medical bills, according to a study published in the Journal of the American College of Cardiology.

“The costs of managing ASCVD are substantial and constitute a major source of concern at a personal level, especially for low-income families and uninsured patients who generally may not have enough financial reserves with which to offset the burden of unexpected health care expenditures,” Khurram Nasir, MD, MPH, MSc, director of population health and health systems research at the Yale Center for Outcomes Research and Evaluation, said in a press release. “Our study highlights that a substantial proportion of nonelderly ASCVD patients and their families in the U.S. struggle with medical bills.”

National Health Interview Survey data

Javier Valero-Elizondo, MD, MPH, postdoctoral associate at the Yale Center for Outcomes Research and Evaluation, and colleagues analyzed data 6,160 participants with ASCVD from the National Health Interview Survey from 2013 to 2017. Participants completed surveys to collect information on financial distress, food security and cost-related medication nonadherence.

The study population was categorized based on financial hardship: no financial hardship from medical bills, financial hardship from medical bills but able to pay and unable to pay bills at all.

Of the participants in this study, 45.1% were members of families with financial hardship from medical bills (95% CI, 43.4-47.7). In addition, 18.9% of participants reported that they were unable to pay medical bills at all (95% CI, 17.6-20.2).

Compared with higher-income participants, those with low income had increased odds for being in families with any financial hardship from medical bills (OR = 1.34; 95% CI, 1.12-1.59) and the inability to pay medical bills (OR = 2.24; 95% CI, 1.79-2.8). Participants who were uninsured were more likely to be unable to pay medical bills (OR = 3.27; 95% CI, 2.49-4.3) or be members of families with any financial hardship from medical bills (OR = 1.86; 95% CI, 1.46-2.36) compared with those who were insured.

Factors of financial hardship

Participants who reported an inability to pay medical bills were more likely to have food insecurity (OR = 2.89; 95% CI, 2.14-3.9), high financial distress (OR = 3.6; 95% CI, 2.68-4.82) and cost-related medication nonadherence (OR = 3.39; 95% CI, 2.44-4.71) compared with those without financial hardship from medical bills after adjusting for established cofounders. The combination of these three consequences was higher in participants who were unable to pay medical bills at all vs. those without financial hardship from bills (19% vs. 2%; P < .0001).

“Our study underscores the fact that although insurance coverage is critical to protect against risk of financial burden from unexpected medical bills, current insurance structure falls short in protecting from financial hardship,” Valero-Elizondo and colleagues wrote. “The vast majority of individuals with ASCVD reporting problems paying bills and paying them over time are insured.” – by Darlene Dobkowski

Disclosures: Nasir and Valero-Elizondo report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Khurram Nasir
Khurram Nasir

More than 45% of patients with atherosclerotic CVD were members of families with financial hardship related to medical bills, according to a study published in the Journal of the American College of Cardiology.

“The costs of managing ASCVD are substantial and constitute a major source of concern at a personal level, especially for low-income families and uninsured patients who generally may not have enough financial reserves with which to offset the burden of unexpected health care expenditures,” Khurram Nasir, MD, MPH, MSc, director of population health and health systems research at the Yale Center for Outcomes Research and Evaluation, said in a press release. “Our study highlights that a substantial proportion of nonelderly ASCVD patients and their families in the U.S. struggle with medical bills.”

National Health Interview Survey data

Javier Valero-Elizondo, MD, MPH, postdoctoral associate at the Yale Center for Outcomes Research and Evaluation, and colleagues analyzed data 6,160 participants with ASCVD from the National Health Interview Survey from 2013 to 2017. Participants completed surveys to collect information on financial distress, food security and cost-related medication nonadherence.

The study population was categorized based on financial hardship: no financial hardship from medical bills, financial hardship from medical bills but able to pay and unable to pay bills at all.

Of the participants in this study, 45.1% were members of families with financial hardship from medical bills (95% CI, 43.4-47.7). In addition, 18.9% of participants reported that they were unable to pay medical bills at all (95% CI, 17.6-20.2).

Compared with higher-income participants, those with low income had increased odds for being in families with any financial hardship from medical bills (OR = 1.34; 95% CI, 1.12-1.59) and the inability to pay medical bills (OR = 2.24; 95% CI, 1.79-2.8). Participants who were uninsured were more likely to be unable to pay medical bills (OR = 3.27; 95% CI, 2.49-4.3) or be members of families with any financial hardship from medical bills (OR = 1.86; 95% CI, 1.46-2.36) compared with those who were insured.

Factors of financial hardship

Participants who reported an inability to pay medical bills were more likely to have food insecurity (OR = 2.89; 95% CI, 2.14-3.9), high financial distress (OR = 3.6; 95% CI, 2.68-4.82) and cost-related medication nonadherence (OR = 3.39; 95% CI, 2.44-4.71) compared with those without financial hardship from medical bills after adjusting for established cofounders. The combination of these three consequences was higher in participants who were unable to pay medical bills at all vs. those without financial hardship from bills (19% vs. 2%; P < .0001).

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“Our study underscores the fact that although insurance coverage is critical to protect against risk of financial burden from unexpected medical bills, current insurance structure falls short in protecting from financial hardship,” Valero-Elizondo and colleagues wrote. “The vast majority of individuals with ASCVD reporting problems paying bills and paying them over time are insured.” – by Darlene Dobkowski

Disclosures: Nasir and Valero-Elizondo report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.