Abstract 13668: Out-of-Pocket Health Spending and Subjective Financial Hardship in Atherosclerotic Cardiovascular Disease and Heart Failure in the United States

Abstract

Introduction: Financial burden from healthcare expenses in families with members with CVD like ASCVD and HF have focused on studying either the costs incurred by patients or their subjective challenges with paying medical bills. We evaluated the full extent of financial toxicity of healthcare on patients with CVD, which has implications for cost-based quality measures and designing interventions. Methods: All families with ≥1 member with ASCVD or HF in the Medical Expenditure Panel Survey (MEPS), 2014-18, were included. Objective financial hardship (OFH) was defined as annual out-of-pocket medical expenses exceeding 20% of annual income. Expenses included care costs and insurance premiums. Subjective financial hardship (SFH) was defined as self-reported problems with paying medical bills, medical bills being paid over time or inability to pay medical bills. Results: There were 10,390 families in MEPS with ≥1 member with ASCVD, representing 21 million families nationally, and 783 families in MEPS with ≥1 HF member, representing 1.7 million families nationally. Among families with ASCVD, 12.4% (95% CI 11.5% - 13.3%) experienced OFH, and 26.6% (25.4% - 27.7%) reported SFH. Collectively, 35% (33% - 36%) experienced either OFH or SFH, but only 4.4% (3.9% - 4.8%) experienced both (Fig A). Similarly, in HF, 43% families experienced at least one form of financial burden, but fewer experiencing OFB rather than SFB burden (14.1% vs 35.5%), and only 6.1% (95% CI 3.9% - 8.4%) experienced both. There patterns were consistent across key subgroups, but younger age and high income were associated with discordant OFH and SFH (Fig B). Conclusions: In 2014-18, nearly 50% of families with ASCVD or HF experienced financial hardship from medical expenses, but a focus on objective or subjective measures alone would have captured only half the burden. Measurements of financial toxicity and a study of mechanisms would need to assess factors underlying both objective and subjective measures.