One in five US patients with atherosclerotic cardiovascular disease cannot pay their medical bills

Javier Valero-Elizondo

A review, published in the Journal of the American College of Cardiology, of the financial hardship associated with atherosclerotic cardiovascular disease (such as coronary heart disease, myocardial infarction, angina, and stroke) indicates that one in five patients are unable to pay medical bills related to their condition. Furthermore, of those who are unable to pay medical bills, at least one third are at risk of receiving inadequate medical care—such as cost-related medical non-adherence.

Javier Valero-Elizondo (Center for Outcomes Research and Evaluation, New Haven Health, New Haven, USA) and others write that atherosclerotic cardiovascular disease (ASCVD) “is not only the leading cause of mortality and morbidity in the USA, but it is also responsible for the highest healthcare costs for a single class of disease”. They add that even people with the condition who are insured are inadequately protected against financial hardship “due to the high costs of insurance, including deductible, copays, and coinsurances”. However, Valero-Elizondo et al note that national estimates of burden of financial hardships related to medical bills among patients with ASCVD are lacking. Thus, to address this issue, they reviewed data for non-elderly (18–64) patients with ASCVD from the National Health Interview Survey.

Of 6,160 patients with self-reported ASCVD, 2,741 (45%) said that they were part of families that experienced financial hardship from medical bills. Furthermore, 1,229 (18.9%) said that they were unable to pay their medical bills at all. As to be expected, in a stratified analysis, uninsured and low-income individuals had the highest burden of financial hardship related to medical bills.

Additionally, of those who were not able to pay medical bills, most experienced at least one of the following consequences: financial distress (worry), food insecurity, or cost-related medical adherence. In fact, 22% experienced two of these consequences and 19% experienced all three consequences (20% experienced one of these consequences); only 38% reported experiencing none of these consequences.

While uninsured patients had the highest burden of financial hardship related to medical bills, most patients (76%) reporting being unable to pay their medical bills were actually insured. Valero-Elizondo comment: “Our study underscores the fact that although insurance coverage is critical to protect against risk of financial burden from unexpected medical bills, the current insurance structure falls short in protecting from financial hardship.”

They conclude that the current US healthcare system “fails to protect a significant proportion of non-elderly atherosclerotic cardiovascular disease patients from financial hardships and its dire consequences”.

Valero-Elizondo told Cardiovascular News: “We firmly believe that this problem not only resides at the policy level; sure, we need to address it, but the change needs to come from all of us. We are all in this together. So, as physicians (and part of healthcare provider teams), we need to find better and more efficient ways to talk to our patients about their financial troubles/worries, either by screening them early in their disease path, or talking to those already in our care. Two of the main reasons we decided to study ASCVD is because it is highly preventable and there is a myriad of treatment options that can help the patients navigate their disease without having to go bankrupt.

“As for patients and their families, we strongly advice to talk to your healthcare provider. It may be uncomfortable at first, but this is the way to mitigate many (present or future) expenditures. At the end of the day, healthcare providers need to increase cardiovascular prevention efforts, and all of us —healthcare providers and patients (and their families) need to get this conversation started.”


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