(Good Medical Health) – According to a US study, about 45% of Americans under 65 with cardiovascular disease have financial problems related to their medical bills.

And nearly one in five can not afford to pay medical bills.

"Patients and doctors often do not discuss financial difficulties or distress – they are due to feelings of discomfort, judgment, fear or even stigma", the lead author of The study, Dr. Javier Valero-Elizondo of Yale University in New Haven, Connecticut, said by e-mail.

This type of distress has become so common among Americans with chronic diseases that scientists have begun to talk about "financial toxicity," an expression coined to evoke side effects similar to drug or surgery-related complications that may have lasting effects on patients. Mental Health.

In this study, researchers focused on adults under 65 years of age with atherosclerotic cardiovascular disease (ASCVD), a condition that includes heart attacks and blockages or narrowing of the arteries of the heart or chest pain. by a reduction of blood flow to the heart.

The researchers point out that ASCVD is the leading cause of death and disability in the United States and one of the most expensive conditions for patients, notes the Journal of the American College of Cardiology. Even among insured patients, many people suffering from these heart problems are prone to financial difficulties because of the high cost of insurance, including deductibles, co-payment and co-insurance.

The authors of the study note that patients with heart disease usually have health costs of over $ 2,000 a year, of which more than half are paid for drugs.

"ASVVD's management costs are significant and a major source of personal concern, particularly for low-income families and uninsured patients, who may not generally have the best health care. sufficient financial reserves to offset the burden of unforeseen health expenses, "said Dr. Khurram Nasir, senior author, also of Yale University.

To assess the financial burden of heart disease, researchers examined data from national health interview surveys conducted between 2013 and 2017 among 6,160 adults under 65 with heart disease.

Survey respondents were defined as having financial difficulties with medical bills if they or a family member reported having problems paying medical bills in the past year or currently paying medical bills in the past year. over time. If they reported problems paying their bills, they were then asked if they had bills that they were unable to pay.

Low-income and high-income individuals, as well as insured and uninsured individuals reported financial hardship and inability to pay; However, the heaviest financial burden and inability to pay have been reported among uninsured and poor Americans.

The study found that about one-third of patients with heart disease and whose health care bills had financial difficulties had to reduce their basic needs, such as food or refrain from taking the drugs they needed. One in five patients unable to pay their bills had to reduce their food and medicine expenses.

One of the limitations of the study is that researchers did not have sufficient data on medical bills to explore the exact amount of patients' personal expenses or the proportion of their income that can be used to pay these bills.

Another disadvantage is that although the study included patients with heart disease who had stress related to medical or unpaid bills, it did not indicate whether money problems were related to bills for heart disease or another disease.

Still, the findings suggest that a large number of heart patients are so financially stressed by the health costs that they are skipping drugs that can prevent complications and death from heart disease, said Dr. David Himmelstein, public health researcher at the University of New York City at Hunter College who did not participate in the study.

"Basically, unless you're Jeff Bezos, you're just a serious illness from financial ruin," Himmelstein said via e-mail. "To solve this problem, we need a major overhaul of health insurance – I am in favor of a reform of the single payer system – and improved coverage of disability coverage."

SOURCE: bit.ly/2I5W5AU Journal of the American College of Cardiology, online February 11, 2019.