Insurance Status Among Adults With Hypertension—The Impact of Underinsurance

Abstract

BackgroundHypertension is a major risk factor for heart disease and stroke. Health insurance coverage affects hypertension treatment and control, but limited information is available for US adults with hypertension who are classified as underinsured.Methods and ResultsUsing Behavioral Risk Factor Surveillance System 2013 data, we identified adults with self‐reported hypertension. On the basis of self‐reported health insurance status and health care–related financial burdens, participants were categorized as uninsured, underinsured, or adequately insured. Proxies for health care received included whether they reported taking antihypertensive medications and whether they visited a doctor for a routine checkup in the past year. We assessed the association between health insurance status and health care received, adjusting for selected sociodemographic characteristics. Among 123 257 participants from 38 states and District of Columbia with self‐reported hypertension, 12% were uninsured, 26% were underinsured, and 62% were adequately insured. In adjusted models using adequately insured participants as referent, both uninsured (adjusted odds ratio, 0.39; 95% CI, 0.35–0.43) and underinsured (0.83, 0.76–0.89) participants were less likely to report using antihypertensive medication than those of adequately insured participants. Similarly, adjusted odds ratio of visiting a doctor for routine checkup in the past year were 0.25 (0.23–0.28) for those who were uninsured and 0.78 (0.72–0.84) for those who were underinsured compared to those with adequate insurance.ConclusionsUninsured and underinsured participants with hypertension were less likely to report receiving care compared to those with adequate insurance coverage. Disparities in health care coverage may necessitate targeted interventions, even among people with health insurance.

Association of Out-of-Pocket Annual Health Expenditures With Financial Hardship in Low-Income Adults With Atherosclerotic Cardiovascular Disease in the United States

“…22 All cost and income estimates were inflation-adjusted to represent 2015 US dollars. 23 Annual out-of-pocket health care expenses in excess of 20% of the annual postsubsistence income were defined as high financial burden. Expenses that exceeded 40% of the annual postsubsistence income were defined as catastrophic financial burden, consistent with its definition endorsed by the World Health Organization.…”

The ramifications of recent health policy actions for cardiovascular care of women: Progress, threats, and opportunities

“…The survey also concluded that women without insurance coverage often received a lower standard of care and had poorer health than those who had insurance . Cardiovascular outcomes for low income and minority women are poorer than their white female and all male counterparts, and is likely in part due to insurance coverage …”

“…4,5 Cardiovascular outcomes for low income and minority women are poorer than their white female and all male counterparts, and is likely in part due to insurance coverage. 6,7 Chronic health diseases and conditions, such as heart disease, cancer, and diabetes, have been the leading cause of death for women. Nearly half of all adults-133 million people-have a chronic illness, and half of those have 2 or more chronic conditions.…”

Health Insurance and Blood Pressure Control

“…In this issue of the Journal of the American Heart Association ( JAHA ), Fang et al advance our understanding of the impact of being underinsured on access to care among persons with hypertension . They examined data from nearly 125 000 adult participants in the 2013 Behavioral Risk Factor Surveillance System (BRFSS) who self‐reported having health provider–diagnosed hypertension (excluding those with reported having borderline or prehypertension).…”

“…In this issue of the Journal of the American Heart Association (JAHA), Fang et al advance our understanding of the impact of being underinsured on access to care among persons with hypertension. 12 They examined data from nearly 125 000 adult participants in the 2013 Behavioral Risk Factor Surveillance System (BRFSS) who self-reported having health provider-diagnosed hypertension (excluding those with reported having borderline or prehypertension). They assessed the relationship between self-reported insurance status (stratified into uninsured, underinsured, and adequately insured) and self-reported proxies for health care received (eg, taking antihypertensive medications and visiting a doctor for a routine checkup within the past year).…”