Out-of-pocket healthcare expenditure burdens among nonelderly adults with hypertension

Objectives: To examine the prevalence of high out-of-pocket burdens and self-perceived financial barriers to care among patients receiving hypertension treatment. Study Population: Persons 18 to 64 years receiving treatment for hypertension from a nationally representative sample of the US population from the 2007 to 2009 Medical Expenditure Panel Survey. Main Outcome Measures: The proportion of persons living in families with high a out-ofpocket burden associated with medical spending relative to income, defining high healthcare burden as spending on healthcare greater than 20% of income and high total burden as spending on healthcare and insurance premiums greater than 20% of income. Results: The prevalence of high total burdens was significantly greater for persons receiving treatment for hypertension (13.1%) compared with other chronically ill (10.5%) and well patients (5.3%). Among hypertension patients with high total burdens, 15.7% said they were unable to get care and 13.6% said they delayed care due to financial reasons. Self-perceived financial barriers were highest among the uninsured and those with public coverage: 35.2% among the uninsured and 23.9% among those with public coverage said they were unable to get care due to financial reasons. Conclusions: High burdens may deter patients from getting needed care. Our findings have 2 distinct policy implications. First, raising awareness among providers regarding the prevalence of high out-ofpocket burdens and financial barriers to care may encourage physicians to discuss healthcare coverage and associated costs with their patients. To the extent that patients' perceptions about their ability to pay are incorrect, physicians can help patients overcome barriers to treatment. Second, health plans could reduce patient cost sharing on drugs for which there is a strong body of evidence documenting cost-saving treatment such as antihypertensive medication. Addressing financial barriers to care may improve treatment adherence among patients with hypertension.