Meeting NewsPerspective

Health care costs often catastrophic for uninsured patients with acute MI, stroke

Rohan Khera

ANAHEIM, Calif. — Before the Affordable Care Act was implemented in 2012, most U.S. patients without health insurance who were hospitalized for acute MI, stroke or CABG surgery were likely to incur catastrophic health care expenses, according research presented at the American Heart Association Scientific Sessions.

Researchers for two studies evaluated data from the National Inpatient Sample from 2008 to 2012 on patients aged 18 to 64 years without insurance. Catastrophic health expenditures were defined as hospitalization charges that exceeded 40% of annual income after subtracting food expenses.

Among uninsured patients in this age group, health bills exceeded the threshold for catastrophic health expenses for 85% (95% CI, 85-85) of patients hospitalized for acute MI, 75% (95% CI, 75-75) of patients hospitalized for stroke and 82.7% (95% confidence interval, 82-83.4) of patients undergoing CABG.

Costs of acute MI, stroke

Rohan Khera, MD, cardiology fellow at University of Texas Southwestern Medical Center, Dallas, and colleagues identified 39,296 hospitalizations for acute MI and 29,182 for stroke, estimating to 188,192 hospitalizations for acute MI and 139,687 hospitalizations for stroke nationally. Uninsured patients accounted for 15% of both patients with acute MI and stroke, according to the data.

Median hospitalization charges were $53,384 (interquartile range [IQR], 33,282-84,551) and $31,218 (IQR, 18,805-60,009) for stroke, according to data presented here. Predictors of increased risk for catastrophic health expenses included low income, high comorbidity burden and urban location.

“The study highlights that heart attack and stroke are unexpected major health care events. One in eight events in the nonelderly before the Affordable Care Act (ACA) were among the uninsured. Further, we found that the hospitalization bills for these events exceed the financial means of a large majority of uninsured patients,” Khera told Cardiology Today.

“Our study does not account for the effect of posthospitalization financial effects of heart attack or stroke, specifically due to lost productivity and/or costs of drugs and care following discharge from the hospital, which may have further financial consequences,” he said.

Costs of CABG

In a related study, Jonathan C. Hong, MD, from the University of British Columbia in Vancouver, Canada, and colleagues identified 9,174 hospitalizations for uninsured patients undergoing CABG, estimating to 44,250 hospitalizations nationally. About 9% of patients were uninsured.

Median hospitalization costs for uninsured patients undergoing CABG were $36,083 (IQR, 27,703-48,400), according to the study results. Higher Charlson comorbidity index was a significant predictor of catastrophic health care expenses. Specifically, the odds were more than twice as high for patients with a Charlson comorbidity index greater than 4 vs. 0 to 2 (OR = 2.45; 95% CI, 1.77-3.4).

“Catastrophic health expenses are an important factor for physicians to consider, and should be thought of as an adverse effect when hospitalization is required for uninsured patients in the United States,” Hong said in a press release.

“Publicly available data tell us that the implementation of the ACA led to a decrease in the number of uninsured Americans substantially. Our study highlights that understanding the financial implications of lacking insurance coverage, particularly for unanticipated major health care events, is important in the current health policy debate surrounding the future of the ACA,” Khera told Cardiology Today. – by Melissa Foster

References:

Khera R, et al. Abstract 293.

Hong JC, et al. Abstract T5082. Both presented at: American Heart Association Scientific Sessions; Nov. 11-15, 2017; Anaheim, California.

Disclosures: Khera and Hong report no relevant financial disclosures.

 

Rohan Khera

ANAHEIM, Calif. — Before the Affordable Care Act was implemented in 2012, most U.S. patients without health insurance who were hospitalized for acute MI, stroke or CABG surgery were likely to incur catastrophic health care expenses, according research presented at the American Heart Association Scientific Sessions.

Researchers for two studies evaluated data from the National Inpatient Sample from 2008 to 2012 on patients aged 18 to 64 years without insurance. Catastrophic health expenditures were defined as hospitalization charges that exceeded 40% of annual income after subtracting food expenses.

Among uninsured patients in this age group, health bills exceeded the threshold for catastrophic health expenses for 85% (95% CI, 85-85) of patients hospitalized for acute MI, 75% (95% CI, 75-75) of patients hospitalized for stroke and 82.7% (95% confidence interval, 82-83.4) of patients undergoing CABG.

Costs of acute MI, stroke

Rohan Khera, MD, cardiology fellow at University of Texas Southwestern Medical Center, Dallas, and colleagues identified 39,296 hospitalizations for acute MI and 29,182 for stroke, estimating to 188,192 hospitalizations for acute MI and 139,687 hospitalizations for stroke nationally. Uninsured patients accounted for 15% of both patients with acute MI and stroke, according to the data.

Median hospitalization charges were $53,384 (interquartile range [IQR], 33,282-84,551) and $31,218 (IQR, 18,805-60,009) for stroke, according to data presented here. Predictors of increased risk for catastrophic health expenses included low income, high comorbidity burden and urban location.

“The study highlights that heart attack and stroke are unexpected major health care events. One in eight events in the nonelderly before the Affordable Care Act (ACA) were among the uninsured. Further, we found that the hospitalization bills for these events exceed the financial means of a large majority of uninsured patients,” Khera told Cardiology Today.

“Our study does not account for the effect of posthospitalization financial effects of heart attack or stroke, specifically due to lost productivity and/or costs of drugs and care following discharge from the hospital, which may have further financial consequences,” he said.

Costs of CABG

In a related study, Jonathan C. Hong, MD, from the University of British Columbia in Vancouver, Canada, and colleagues identified 9,174 hospitalizations for uninsured patients undergoing CABG, estimating to 44,250 hospitalizations nationally. About 9% of patients were uninsured.

Median hospitalization costs for uninsured patients undergoing CABG were $36,083 (IQR, 27,703-48,400), according to the study results. Higher Charlson comorbidity index was a significant predictor of catastrophic health care expenses. Specifically, the odds were more than twice as high for patients with a Charlson comorbidity index greater than 4 vs. 0 to 2 (OR = 2.45; 95% CI, 1.77-3.4).

PAGE BREAK

“Catastrophic health expenses are an important factor for physicians to consider, and should be thought of as an adverse effect when hospitalization is required for uninsured patients in the United States,” Hong said in a press release.

“Publicly available data tell us that the implementation of the ACA led to a decrease in the number of uninsured Americans substantially. Our study highlights that understanding the financial implications of lacking insurance coverage, particularly for unanticipated major health care events, is important in the current health policy debate surrounding the future of the ACA,” Khera told Cardiology Today. – by Melissa Foster

References:

Khera R, et al. Abstract 293.

Hong JC, et al. Abstract T5082. Both presented at: American Heart Association Scientific Sessions; Nov. 11-15, 2017; Anaheim, California.

Disclosures: Khera and Hong report no relevant financial disclosures.

 

    Perspective

    The trouble with hospitalization costs is that they’re not particularly based on the reality of [hospitalization]. I practice medicine every day, and if you come in without insurance, you’re not going to be charged the full charge; it would likely be a lower charge, so the numbers make it difficult to be precise. Having said that, if you don’t have insurance, it’s a bad place to be. The conclusions of this study are not surprising. It tells us that, at the very least, no matter what the solution is for health insurance in the country, there has to be catastrophic coverage. Maybe we won’t have good preventative coverage, but catastrophic coverage is going to be a must no matter what the formula.

    • Vincent Bufalino , MD
    • Medical Director, Advocate Heart Institute

    Disclosures: Bufalino reports no relevant financial disclosures.

    Perspective

    Robert H. Eckel

    This study delves into the politics of health care economics, and I’d like to reserve a statement on that. I don’t know what the best health care system looks like. There are limitations to a government-run system, but ultimately, countries that do it have a lot more information that we can understand and then make population-based decisions. In a way, it doesn’t surprise me.
    When I attend on the general internal medicine ward at the hospital, I don’t take care of people in the CCU, but I see people on that floor, and disposition for the uninsured often makes discharge difficult. Although the researchers matched hospitalization costs for the two groups, which is good, there’s often no place to go and there’s no family that steps up. I can say that this is one reason why hospitalization is so expensive.
    It’s a dramatic finding that 85% of people that have bypass surgery or are admitted to the hospital for an acute MI or stroke have a significant financial burden. We need a better health care system, no matter what it looks like.

    • Robert H. Eckel, MD
    • Professor of Medicine, Division of Endocrinology, Metabolism, Diabetes and Cardiology
      Professor, Physiology and Biophysics
      Charles A. Boettcher II Chair in Atherosclerosis
      University of Colorado Denver Anschutz Medical Center
      Director, Lipid Clinic
      University of Colorado Hospital, Aurora
      Past President, American Heart Association

    Disclosures: Eckel reports serving as a consultant/advisory board member for Novo Nordisk.

    See more from American Heart Association Scientific Sessions