Cost: A Deadly Barrier to Health Care

March 13, 2007 -- Short on cash? Don't have a heart attack.

That is very cold advice. Nobody wants to have a heart attack. But if you do have one -- and if your financial situation means you sometimes have to cut back on health care -- you're less likely to recover as fully as more fortunate Americans.

The finding comes from a study of 2,498 heart attack patients treated in medical centers across the U.S. Nearly one in five patients said they sometimes avoided getting health care because of cost. And nearly 13% said that cost kept them from taking the drugs they needed.

"Financial barriers are potent risk factors for adverse outcomes after heart attacks," study leader Harlan M. Krumholz, MD, Yale University professor of medicine, said at a news conference. "Financial barriers are associated with greater symptoms, worse quality of life, and a higher risk of being readmitted to hospital after a heart attack."

It's not simply a matter of health insurance. More than two-thirds of heart attack patients who can't afford proper health care have health insurance, the study showed.

Can't Pay? Back to the Hospital

Even when they got exactly the same hospital care immediately after their heart attack, patients who later encountered financial barriers did worse.

A year after their heart attacks:

• Patients with financial barriers to health care services were 30% more likely to need a second hospital visit for heart symptoms than were patients without financial barriers.
• Patients with financial barriers to prescription drugs were 70% more likely to need a second hospital visit for heart symptoms.
• Patients with financial barriers to prescription drugs were 55% more likely to suffer angina -- chest pain due to reduced blood flow to the heart muscle.
• Quality of life was significantly worse for patients with financial barriers to health care and medication.

"Is it OK for us to live in a country where, when you leave the hospital, your financial circumstances dictate your quality of life?" Krumholz said. "Are we, as a country, going to find that repugnant?"

The findings appear in the March 14 issue of TheJournal of the American Medical Association. The issue is dedicated to articles addressing U.S. access to health care. The news conference at which Krumholz spoke was organized by the journal's editors.