Over 45 percent of adult atherosclerotic cardiovascular disease (ASCVD) patients suffer financial hardship related to their medical bills, including many who cannot pay their medical bills at all, according to a cardiovascular medicine and society paper published Feb. 11 in the Journal of the American College of Cardiology.

ASCVD has the highest health care costs for a single class of disease. Even among insured patients, many people with ASCVD are prone to financial hardship because of the high cost of insurance, including deductibles, co-pays and co-insurances. However, there is a lack of data on the full impact of this financial burden.

Javier Valero-Elizondo, MD, MPH, looked at data from the National Health Interview Survey from 2013-2017 to assess the national burden of financial hardship from medical bills among individuals with ASCVD, as well as potential consequences, including financial distress, food insecurity and cost-related medication non-adherence.

The study population of 6,160 adults ages 18-64 with ASCVD was divided into three categories: "no financial hardship from medical bills," "financial hardship from medical bills but able to pay," and "unable to pay bills at all." Researchers found that 45.1 percent were part of families that reported having financial hardship from medical bills, and 18.9 percent reported being unable to pay their medical bills at all. Lower-income and higher-income individuals, as well as insured and uninsured reported financial hardship and inability to pay; however, the highest burden of financial hardship and inability to pay was reported among uninsured and low-income individuals.

The authors also reported that nearly one in three ASCVD patients with financial hardship from their medical bills said they were suffering from financial distress, were cutting back on basic amenities such as food or were not taking needed medications as a result. One in five patients unable to pay medical bills reported all three situations.

Limitations of the study include that the construct used to define financial hardship from medical bills was based upon available data in the survey. Also, the question that asked not only about an individual but if anyone in the household had financial hardship from medical bills, precludes direct assessment of the proportion of medical bills related to ASCVD. However, a recent study found that health care spending on ASCVD patients represented a mean of 70 percent of overall family out of pocket health care spending.

"Our study underscores the fact that while 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," said Khurram Nasir, MD, MPH, MSc, FACC, senior author of the paper. "The vast majority of individuals with ASVCD reporting problems paying bills and paying them over time are insured."

Keywords: Medically Uninsured, Deductibles and Coinsurance, Medication Adherence, Insurance Coverage, Family Characteristics, Health Care Costs

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