Both Men and Women Can Face Financial Barriers After Heart Attack Interview with:
Adam L. Beckman
Yale College, New Haven, CT (at the time this work was completed)
Erica S Spatz MD MHS
Assistant Professor, Section of Cardiovascular Medicine
Center for Outcomes Research and Evaluation
Yale-New Haven Hospital
Yale University School of Medicine What is the background for this study?

Beckman: Despite the expansion of insurance coverage, young adults face major challenges to obtaining affordable healthcare. We suspected women may experience greater challenges than men — they often have lower income and less complete medical coverage than men, and care for multiple generations of family, and that this may in part explain why young women have worse outcomes following a heart attack as compared with similarly-aged men. What are the main findings?

Beckman: Contrary to our hypothesis, both men and women who reported having a financial barrier were significantly worse off one year after their heart attack. Specifically, we saw that young adults with heart attack who reported experiencing financial barriers to healthcare services and medication reported worse quality of life, more depressive symptoms, poorer psychosocial status, and more stress than patients without financial barriers, both while in the hospital and 12 months later. What should readers take away from your report?

Spatz: Our study emphasizes that patients need us to think about their social needs, not just their clinical symptoms. We have not completed our job if we discharge patients from the hospital and recommend they use medications or services like cardiac rehab that they cannot afford.

Beckman: Exactly. The clear relationship between financial barriers and outcomes imply that we need interventions to lessen the impact of financial barriers to healthcare for young individuals. This may include screening young men and women with heart attack for financial barriers. Bottom line is we cannot only focus on the uninsured; in the wake of the Affordable Care Act and expanded access to insurance, we need to pay attention to the negative effects underinsurance may also be having on outcomes. What recommendations do you have for future research as a result of this study?

Beckman: One next step is to identify healthcare delivery models that address the ill effects of financial barriers on outcomes. Programs from the Center for Medicare and Medicaid, such as the bundled payments initiative (that reimburses the entire episode of care including the recovery period, not merely the hospitalization), may better reward providers to help patients overcome those financial challenges and ultimately experience a smoother recovery. Thank you for your contribution to the community.


Sex Differences in Financial Barriers and the Relationship to Recovery After Acute Myocardial Infarction
Adam L. Beckman · Emily M. Bucholz · Weiwei Zhang · […] · Erica S. Spatz
Article · Oct 2016 · Journal of the American Heart Association

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on October 19, 2016 by Marie Benz MD FAAD