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J Am Heart Assoc. 2019 Dec 17;8(24):e008831. doi: 10.1161/JAHA.118.008831. Epub 2019 Dec 16.

Financial Burdens and Barriers to Care Among Nonelderly Adults With Heart Disease: 2010-2015.

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Agency for Healthcare Research and Quality (AHRQ) Rockville MD.
Social & Scientific Systems, Inc. Silver Spring MD.


Background We examined the prevalence of high burdens and barriers to care among adults with heart disease treatment. Methods and Results The participants were aged 18 to 64 years from the Medical Expenditure Panel Survey-Household Component (MEPS-HC) for 2010-2015. High burden is out-of-pocket spending on care and insurance premiums >20% of income. Barriers to care are forgoing and delaying care for financial reasons. Logistic regressions were used to estimate the odds of having high burdens and barriers. Adults treated for heart disease have odds ratios (ORs) of 2.18 (95% CI, 1.91-2.50) for having high burden, 2.51 (95% CI, 2.23-2.83) for forgoing care, and 3.57 (95% CI, 3.8-4.13) for delaying care compared with adults without any chronic condition. Among adults treated for heart disease compared with adults with private group coverage, ORs for having high burdens were significantly lower among those with public insurance (OR: 0.17; 95% CI, 0.10-0.26) or the uninsured (OR: 0.58; 95% CI, 0.36-0.92) and higher among those with private nongroup insurance (OR: 5.30; 95% CI, 3.26-8.61). Compared with adults with private group coverage, ORs for delaying care were 2.07 (95% CI, 1.37-3.12) for those with public insurance, 2.64; 95% CI, 1.70-4.10) for those without insurance, and 2.16 (95% CI, 1.24-3.76) for those with private nongroup insurance. Conclusions Public insurance provides protection against high burdens but not against forgoing or delaying care. Future research should investigate whether and to what extent barriers to care are associated with worse health outcomes and higher costs in the long term.


barriers to care; financial burdens; heart disease treatment

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