AJMC Study Confirms Link Between Financial Stress, Failure to Stick With Hypertension Medication

PLAINSBORO, N.J. — A study published this month in The American Journal of Managed Care adds to the evidence that financial pressures — or the perception of them – may keep patients from getting treatment or taking medication for chronic conditions, such as hypertension.

Authors Didem Minbay Bernard, PhD; Patrik Johansson, MD, MPH; and Zhengyi Fang, MS examined data for persons aged 18 to 64 years from the Medical Expenditure Panel Survey-Household Component for the period 2007 to 2009. This would cover adults who were not yet eligible for Medicare, and would include persons with different types of health insurance: private plans, both group and non-group; publicly funded plans, such as Medicaid; or those without coverage. For the full study, click here.

The authors found that persons with hypertension were more likely to have high healthcare burdens, relative to family income, than those with other chronic conditions or those who were well. For example, 24 percent of those with hypertension also had a mental health disorder. When patients with limited means must foot the bill to treat multiple conditions, hypertension apparently may take a back seat.

The authors say their findings should be a wake-up call to doctors and other healthcare providers: Financial burdens to getting care or taking medication must be discussed directly, in part to determine whether the patient is eligible for assistance he or she does not know exists.

“Hypertension represents the most common reason for office visits to primary care physicians. However, recent studies show that 80 percent of physicians are unaware of medication costs and also misunderstand the complexities of health coverage,” the authors write. Physicians must become more aware of how financial pressures affect care, they said, and health plans should reconfigure cost-sharing to reduce out-of-pocket costs where there is strong evidence that treatment works.

For purposes of the study, healthcare burdens included all health-related spending, such as deductibles and co-payments, cost-sharing, and payments for services not covered by insurance. Total burdens included healthcare costs plus additional spending on premiums, for those on private non-group plans.

Among those being treated for hypertension, spending on healthcare could consume large shares of a family’s resources, even if the family had coverage during the study period. The authors found:

• Overall, persons with hypertension were more likely to be on publicly funded insurance or have no coverage, and these groups spent 18.6 percent (public insurance) and 21 percent (no coverage) of family income on healthcare.
• While smaller in number, those with hypertension who had private coverage outside of a group plan had an alarming total burden of 49.9 percent of family income, with the bulk of the cost going toward insurance premiums.

The study also looked at responses from patients who had been treated for hypertension in the past year but were not being treated when they were surveyed. About 73 percent of patients in this situation thought delaying care was a problem, whether they had healthcare burdens above 20 percent of family income, or burdens below that mark. Hypertension patients who were not receiving care and who had healthcare burdens above 20 percent reported the following:

• 15.7 percent were unable to get care for financial reasons
• 13.6 percent delayed care due to financial reasons

For both responses, those most likely to not receive care or delay care were the uninsured, following by those with publicly funded healthcare.

The good news, the authors wrote, is that the Affordable Care Act (ACA) may reduce out-of-pocket costs for those who previously lacked access to group health insurance. “The ACA sets limits on out-of-pocket spending for deductibles, coinsurance and co-payments,” they wrote, with 2014 maximums set at $6,350 for an individual and $12,700 for a family.

About the Journal

The American Journal of Managed Care, now in its 20^th year of publication, is the leading peer-reviewed journal dedicated to issues in managed care. In December 2013, AJMC launched The American Journal of Accountable Care, which publishes research and commentary devoted to understanding changes to the healthcare system due to the 2010 Affordable Care Act. AJMC’s news publications, the Evidence-Based series, bring together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in the areas of oncology, diabetes management, respiratory care, and immunology and infectious disease.

CONTACT: Mary Caffrey (609) 716-7777 x 144

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