High insurance deductibles may stop people from seeking emergency care for chest pain

By American Heart Association News

pablohart/E+, Getty Images
(pablohart/E+, Getty Images)

People with high-deductible health plans and lower incomes are less likely to go to the emergency room when experiencing chest pain and are less likely to be admitted to the hospital if they do go, a new study finds.

That can have dangerous consequences. Published Monday in the American Heart Association journal Circulation, the study found people with lower incomes were more likely to have a heart attack when later admitted to the hospital.

"People with higher deductibles delay treatment and are sicker when they show up in the ER for chest pain," lead study author Dr. Shih-Chuan Chou said in a news release. Chou is an emergency care physician in the department of emergency medicine at Brigham and Women's Hospital in Boston.

"Cost is a real factor for patient outcomes," he said.

Chest pain, also called angina, can feel like pressure or squeezing in the chest. It is one of the most common reasons for emergency room visits and can signal underlying heart problems. It often is an early warning sign for a heart attack. Angina typically happens because the heart muscle isn't getting enough oxygen-rich blood. This also can cause discomfort in the shoulders, arms, neck, jaw, back and stomach or can feel like indigestion.

Each year, up to 7 million people seek emergency care for chest pain. But people who pay more out-of-pocket for medical care and who have less money to cover those costs often are reluctant to do so, research shows.

As employers continue to shift workers into high-deductible plans, a greater number of people are at risk. As of last year, more than half of U.S. employees were enrolled in a high-deductible health plan, according to the national Employer Health Benefits Survey.

"Shifting the high cost of health care from insurers and employers to patients has become a trend across the U.S.," Chou said. "When people with low incomes are switched to high-deductible plans, they are disproportionately impacted financially and so is their health."

In the new study, researchers compared health data for people enrolled in insurance plans with annual deductibles of $500 or less to those with $1,000 or more, including people whose employers shifted them from low-deductible plans to higher ones.

Among people who switched from a low-deductible plan to a higher one, visits to the emergency room due to chest pain dropped by 4%. Emergency room visits that led to hospitalization due to chest pain dropped by 11% in this group. When hospitalized later, those with low incomes and high-deductible plans were nearly one-third more likely to have heart attacks.

"Clinicians need to consider actively including cost in our discussions with patients and in shared decision-making," Chou said. "Insurers and employers need to consider how they will manage high-deductible plans going forward – particularly given the health impact on their employees."

If you have questions or comments about this story, please email [email protected].

American Heart Association News Stories

American Heart Association News covers heart disease, stroke and related health issues. Not all views expressed in American Heart Association News stories reflect the official position of the American Heart Association. Statements, conclusions, accuracy and reliability of studies published in American Heart Association scientific journals or presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect the American Heart Association’s official guidance, policies or positions.

Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. Permission is granted, at no cost and without need for further request, for individuals, media outlets, and non-commercial education and awareness efforts to link to, quote, excerpt from or reprint these stories in any medium as long as no text is altered and proper attribution is made to American Heart Association News.

Other uses, including educational products or services sold for profit, must comply with the American Heart Association’s Copyright Permission Guidelines. See full terms of use. These stories may not be used to promote or endorse a commercial product or service.

HEALTH CARE DISCLAIMER: This site and its services do not constitute the practice of medical advice, diagnosis or treatment. Always talk to your health care provider for diagnosis and treatment, including your specific medical needs. If you have or suspect that you have a medical problem or condition, please contact a qualified health care professional immediately. If you are in the United States and experiencing a medical emergency, call 911 or call for emergency medical help immediately.