Low-Income Patients Are Less Likely To Visit ER For Chest Discomfort

Low-Income Patients Are Less Likely To Visit ER For Chest Discomfort

According to new research published today in the American Heart Association’s journal, people who must spend $1,000 or more annually in out-of-pocket medical deductibles under their health care insurance plan were less likely to go to the emergency room for chest discomfort and less likely to be admitted to the hospital during these visits, compared to people who have health care plans with an yearly deductible of $500 or less.

Low-Income Patients Are Less Likely To Visit ER For Chest Discomfort

When the heart muscle does not receive enough oxygen-rich blood, it can cause chest discomfort. It may feel like squeezing or pressure in the chest. The pain can also be felt in the shoulders, arms, neck, jaw, or back, and it may seem like indigestion. Chest discomfort can be a sign of an underlying heart issue, most often coronary heart disease (CHD). There are many different forms of chest pain, and a medical expert should evaluate every chest discomfort.

Low-Income Patients Are Less Likely To Visit ER For Chest Discomfort

According to the study, health insurers and businesses that run their health plans are progressively transferring the economic burden of health care to individuals. According to the National Employer Health Benefits Survey, more than half of U.S. employees will be enrolled in a high-deductible health plan by 2020. The previous study has demonstrated that individuals’ decisions to delay or avoid getting therapy for a variety of medical problems are influenced by their insurance status and financial worries.

Transferring the high expense of health care from insurance and employers to individuals has become a trend across the United States, according to main research author Shih-Chuan Chou, M.D., M.P.H., S.M., an emergency care physician at Brigham and Women’s Hospital in Boston. Their study is one of the first to look at the effect of a high-deductible health care plan on people’s decisions to go to the emergency room for chest discomfort.

Researchers identified patients ages 19 to 63, enrolled between 2003 and 2014, whose employers offered only low-deductible health plans ($500 or less/year) in the first year and then mandated enrollment in a high-deductible health plan ($1,000 or more/year) in the second year, using a claims database from a nationwide U.S. health insurer. Members in the control group had been enrolled in a low-deductible health plan for two years in a row.

The research comprised almost 500,000 employees in the high-deductible group and over six million in the control group. The average age in both groups was 42; almost half of the participants were women, and roughly two-thirds were non-Hispanic white adults.

To guarantee comparability, researchers matched persons in both groups based on patient-specific demographic and clinical factors as well as employer data such as total staff count. 

They looked at whether moving to a high-deductible health plan affected employees’ utilization of the emergency room for chest discomfort in the first year (the low-deductible year) vs the second year (the high-deductible year). They also examined changes in yearly patient outcomes between the high-deductible health plan group and the matched control group from year one to year two (those with a low-deductible plan for two consecutive years)

Researchers discovered that switching to a high-deductible health plan was linked to a 4% decrease in ER visits for chest discomfort; enrollment in a high-deductible health plan was related with an 11% reduction in ER visits for chest discomfort that resulted in hospitalization; high-deductible health plans were approximately one-third more likely among low-income individuals to suffer a heart attack during a second hospitalization 30 days after their initial ER visit for chest discomfort.

According to Chou, the cost is a real influence on patient care. Clinicians must actively explore integrating cost in interactions with patients and collaborative decision-making. Insurers and businesses must examine how they will manage high-deductible plans in the future, especially given the health implications for their employees.

The inherent bias produced by utilizing an administrative dataset is one of the study’s limitations. However, the study’s methodology assisted in minimizing these shortcomings.


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