How Can We Reduce the Financial Toll of Atrial Fibrillation?
August 24, 2008 6:17 AM CT
I talk a lot in my speeches and programs about the financial toll that atrial fibrillation takes on us and our families, and I have mentioned it in previous articles as well.
A new study from The Commonwealth Fund shares just how pervasive the financial toll of medical costs has become on individuals and families in the United States. Those of us that have suffered with atrial fibrillation will not find this information at all surprising.
“More adults are struggling to pay their medical bills and are accumulating medical debt over time,” says the study. “All told, in 2007 nearly two-thirds of adults, or 116 million people, were uninsured for a time during the year, were underinsured, reported a problem paying medical bills, and/or said they did not get needed health care because of cost.”
Here are some of the key findings from the Commonwealth Fund study:
- Increased uninsured: In 2007, 28% of US adults, about 50 million Americans, were uninsured for some part of the year, up from 24% in 2001.
- Medical costs are taking a large portion of income: The percentage of American adults spending a large portion of their income on medical premiums and out-of-pocket medical expenses grew, with 33% spending 10% or more of their income on health care or health insurance in 2007 compared to 21% in 2001. The number of adults under 65 with out-of-pocket costs (not including insurance premiums) so high relative to income that they were in essence underinsured grew from 9% in 2003 to 14% in 2007, and totaled 25 million people.
- Difficulty paying medical bills: The number of working-age adults having difficulty paying medical bills increased from 34% in 2005 to 41% in 2007, totaling 72 million people. The serious financial difficulty caused by medical bills led to 29% of them being unable to pay for basic needs, such as food, heat, or rent; 39% using up savings; and 30% incurring large credit card debt.
- Avoiding medical care: Because of the high cost of health care, 45% reported problems getting the health care they needed. Many with chronic health problems that were uninsured at any point during the year reported skimping on their medications or needed care because of cost.
So what does all of this mean to those of us who have, or have had, atrial fibrillation? We know the huge financial toll that atrial fibrillation takes. Certainly the growing number of Americans with afib contributes to these numbers. Growing frustration with treatments that don’t work, or that make things worse, is precipitating a massive quest among atrial fibrillation patients to find a cure that can stop their escalating medical burden.
First, and most importantly, we need to be proactive patients, looking out not only for our health, but for our wallets as well. The cost of treating atrial fibrillation varies all across the board, and the more we know, the more efficiently we can use our health care dollars (or whatever your currency is). It’s a partnership with our doctors, and we have to be open with them, including the financial toll it takes. A lot of money is wasted fiddling around with afib, and most doctors are unaware unless we tell them.
Second, many general doctors treating us are in the dark about the best care for atrial fibrillation patients because it is not humanly possible to keep up on all the new findings on all the different conditions that their patients could possibly have. Here are some thoughts about what could help with the growing financial burden of afib:
- The Guidelines for Management of Patients with Atrial Fibrillation (ACC/AHA/ESC) and the Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation (HRS/EHTA/ECAS) have been major steps forward in figuring out the progression of treatments for atrial fibrillation. That work needs to continue because afib is unique from one individual to another and the field is also changing rapidly. But more importantly, these guidelines need to be communicated not only to electrophysiologists and surgeons but to cardiologists and primary care doctors as well. The longer atrial fibrillation goes on, the more difficult, and thus expensive, it becomes to treat and potentially cure.
- What we really need is more integrated atrial fibrillation or arrhythmia centers, with multiple specialties represented—EPs, surgeons, and nurse practitioners to triage and educate patients. That way, the team can determine the best path for each individual patient. I believe that family physicians and cardiologists need to let go of their afib patients and refer them to these specialized centers. They needn’t worry about losing patients – as boomers age, there will be plenty of patients to go around.
We must not keep fiddling around with atrial fibrillation, prolonging treatment while it gets worse, and in many cases bankrupting patients and their families. Neither we, nor our economy, can afford this.
What is your take on this? Click on this link to add your comments over at our Atrial Fibrillation Blog.