Clinical Heart and Vascular Center

Financial Toxicity from Health Care Expenditures in Patients with ASCVD

Rohan Khera
Rohan Khera, M.D.

By Rohan Khera, M.D.
Cardiology Fellow 

One in 10 U.S. adults suffers from atherosclerotic cardiovascular disease (ASCVD). Sufferers of this chronic illness have long-term health care needs and require frequent outpatient visits, daily medications, and often emergency and inpatient care. Health care encounters currently do not assess whether our patients are burdened by health care costs, nor how frequently financial challenges modify their health-related behavior. In a set of studies that we presented at the Scientific Sessions, we lever­aged national data and reported on financial challenges experienced by ASCVD patients and their families.

We made several important observations. First, one in four low-income households with a member with ASCVD experience yearly out-of-pocket health care expenses exceeding 20 percent of their annual income, and nearly one in 10 have expenses that exceed 40 percent of that annual income – levels that are considered finan­cially catastrophic. We found that the rate of such catastrophic financial expenditures was actually higher in those with health insurance, particularly for those with self-purchased private insurance.

In a subsequent evaluation, we found that while uninsured individuals had lower health care costs, this was likely due to the deferral of non-urgent health care. Uninsured individuals with ASCVD had substantially lower odds of accessing outpatient or inpatient health care services for the same set of health conditions as the insured. Notably, they were equally likely to seek emergency medical care.

One in four low- income households with a member with ASCVD experience yearly out-of-pocket health care expenses exceeding 20 percent of their annual income, and nearly one in 10 have expenses that exceed 40 percent.

Rohan Khera, M.D.

In a qualitative assessment, low-income individuals without insurance had nearly four- to fivefold higher odds of forgoing or deferring health care due to cost than those with insurance.

Finally, we found that high financial burden from health care costs had an effect on patient health. Notably, a large proportion reported psychological stress caused by the high financial burden. Further, among low-income individuals with ASCVD, one in four reported not being ad­herent to prescription medications due to their cost alone. Collectively, our observations identify areas that need urgent attention in our clinical practice and in contemporary discussions on health policy.