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Out-of-Pocket Healthcare Expenditure Burdens Among Nonelderly Adults With Hypertension | Page 3

Published Online: May 21, 2014
Didem Minbay Bernard, PhD; Patrik Johansson, MD, MPH; and Zhengyi Fang, MS
The increased prevalence of hypertension risk factors in the United States, in the form of an obesity epidemic and an aging population, underscores the importance of continued hypertension management and control. With the implementation of the Affordable Care Act (ACA), nonelderly adults with hypertension who are currently uninsured or have private non-group insurance will gain access to affordable coverage through the exchanges. Furthermore, the ACA sets limits on out-of-pocket spending for deductibles, coinsurance, and copayments. For the plan year beginning in 2014, the annual out-of-pocket maximums are $6350 for an individual and $12,700 for a family. Coverage through the exchanges and caps on outof- pocket spending are likely to reduce the prevalence of high burdens among adults with hypertension.

Hypertension represents the most common reason for office visits to primary care physicians.32-34 However, recent studies show that 80% of physicians are unaware of medication costs and also misunderstand the complexities of insurance coverage.35,36 Thus, raising awareness among providers regarding the prevalence of high out-of-pocket burdens and self-perceived financial barriers to care may encourage providers to discuss healthcare coverage and associated costs with their patients. To the extent that patients’ perceptions about their ability to pay are incorrect, physicians can change those perceptions. Furthermore, health plans could reduce patient cost sharing on drugs for which there is a strong body of evidence documenting cost-saving treatment such as antihypertensive medication. Addressing financial barriers to care may improve treatment adherence among patients with hypertension.

Take-Away Points

  • Among nonelderly adults with hypertension treatment, 13.1% had high total burdens (ie, healthcare expenditures-healthcare and insurance premiums), accounted for more than 20% of their income. Those with private non-group insurance were the most likely to have high total burdens (49.9%), followed by the uninsured (21.0%), those with public insurance (18.6%), and those with private group insurance (9.3%).

  • Among hypertension patients with high total burdens, 15.7% said they were unable to get care and 13.6% said they delayed care due to financial reasons.

  • Raising awareness among providers regarding the prevalence of high out-of-pocket burdens and self-perceived financial barriers to care may encourage providers to discuss health care coverage and associated costs with their patients. To the extent that patients’ perceptions about their ability to pay are incorrect, physicians can change these perceptions.

  • Furthermore, health plans could reduce patient cost-sharing on drugs for which there is a strong body of evidence documenting cost-saving treatment such as antihypertensive medication. Addressing financial barriers to care may improve treatment adherence among patients with hypertension.
Author Affiliations: Agency for Healthcare Research and Quality— Center for Financing, Access and Cost Trends, Rockville, MD (DMB); University of Nebraska Medical Center, College of Public Health, Omaha, NE (PJ); Social & Scientific Systems, Silver Spring, MD (ZF).

Source of Funding: None reported.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (DMB, PJ); acquisition of data (DMB, ZF); analysis and interpretation of data (DMB, PJ, ZF); drafting of the manuscript (DMB, PJ); critical revision of the manuscript for important intellectual content (DMB); statistical analysis (ZF).

Address correspondence to: Didem Minbay Bernard, Agency for Healthcare Research and Quality, 540 Gaither Rd, Rockville, MD 20850. E-mail: Didem.Bernard@ahrq.hhs.gov.
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Issue: May 2014
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