Feb 4 Not surprisingly, uninsured people in the
United States were less likely to get the best treatment for
heart troubles, especially in terms of medications, than those
with insurance, according to a U.S. study.
In a group of about 61,000 U.S. residents, researchers
writing in the Journal of the American College of Cardiology
found that those without any health insurance were between 6
percent and 12 percent less likely than people with either
public or private insurance to be prescribed drugs that are
considered standard care for heat disease.
"There is some different of treatment. It only applies -
interestingly enough - to uninsured patients," said senior
author Paul Chan, of Saint Luke's Mid American Heart Institute
in Kansas City, Missouri.
In the past, studies have found that uninsured U.S.
residents have worse health outcomes compared to the insured.
They're also less likely to get screenings and preventive care -
possibly because they don't often go to a doctor.
Less is known, though, about uninsured people who do go to
doctors and whether they receive worse care than insured people.
For the study, Chan and his colleagues used data from 2009
on 60,814 heart patients at 30 doctors' offices around the
Of those patients, about 9 percent were uninsured, 71
percent had private insurance, and 20 percent had public
insurance, such as Medicare or Medicaid.
The researchers looked to see which patients received the
recommended medications for their heart conditions and whether
the treatment they got was linked to their insurance status.
Overall, patients with public or private insurance received
about the same number of prescriptions, but the uninsured
patients were less likely to be prescribed drugs, compared to
the insured patients.
For example, about 73 percent of uninsured patients were
prescribed beta-blockers after a heart attack, compared to about
81 percent of privately insured patients. About 89 percent of
uninsured patients received medication for high cholesterol,
compared to about 95 percent of privately insured patients.
"If it's just the lack of insurance, it should not affect
the physicians' decisions to sit down and prescribe (a drug),"
said Ed Havranek, a cardiologist at the Denver Health Medical
Center in Colorado, who wrote a commentary that appeared with
It could be driven by doctors' perceptions of their
patients, he added.
Chan said that uninsured people tend to be sicker and their
other conditions may take priority over heart problems.
"Truth be told, when many of these patients come in it's not
just cardiovascular disease. It's diabetes, obesity and smoking
too," he added.
Havranek said the first step to solving the problem is to do
what Chan and his colleagues did: by shining a light on it and
then finding a practical solution.
"You have to be open to the possibility that you're not
doing things accurately or fairly across patient populations,"
(Reporting from New York by Andrew Seaman at Reuters Health;
editing by Elaine Lies)