Access to Care

Patients with financial worries or no insurance delay going to the hospital for a heart attack

Persons without health care insurance or who have financial concerns about accessing care despite having insurance are more likely to delay going to the hospital to treat a heart attack than insured persons without financial concerns about accessing care, a new study finds. These delays may compromise patients' chances of optimal outcomes following treatment, note the study authors. They recruited patients who were admitted for an acute heart attack at 24 hospitals throughout the United States that participated in a heart attack registry (TRIUMPH). Of the 3,721 patients who experienced a heart attack, 61.7 percent were insured without financial concerns, 18.5 percent were insured but had financial concerns, and 19.8 percent were uninsured.

The patients most likely to have delays of more than 6 hours in seeking hospital care were those who were uninsured (48.6 percent) and those with insurance who had financial concerns about accessing care (44.6 percent). Insured patients without these financial worries (39.3 percent) were least likely to delay seeking care. Prehospital delays of less than 2 hours were noted most commonly for insured patients without financial concerns (36.6 percent), less commonly for those insured who had financial concerns (33.5 percent), and least commonly among the uninsured (27.5 percent). After adjusting for patient characteristics and other confounders, the researchers found that, compared with insured patients who had no financial concerns, uninsured patients had a 38 percent increased likelihood, and the insured who had financial concerns had a 21 percent increased likelihood, of delays in seeking care for their heart attack.

The researchers conclude that efforts to reduce prehospital delays for heart attacks and other emergency conditions will require an integrated approach that combines educational efforts at the patient, community, and national levels, as well as efforts to address the structural issues of access to and affordability of U.S. health care. The study was funded in part by the Agency for Healthcare Research and Quality (HS18283).

More details are in "Health care insurance, financial concerns in accessing care, and delays to hospital presentation in acute myocardial infarction," by Kim G. Smolderen, Ph.D., John A. Spertus, M.D., M.P.H., Brahmajee K. Nallamothu, M.D., M.P.H., and others in the April 14, 2010, Journal of the American Medical Association 303(14), pp. 1392-1400.

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