EDITORIAL
Health Insurance, or Particularly Its Lack, and Healthcare Consequences Among Hypertensive Americans Michael H. Alderman1
Correspondence: Michael H. Alderman ([email protected]). 1Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York.
Initially submitted May 21, 2014; accepted for publication May 21, 2014. doi:10.1093/ajh/hpu128 © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: [email protected]
In this issue of the Journal, Fang and colleagues at the US Centers for Disease Control and Prevention have provided a window into the magnitude of the problem of dissociation of those who are aware of their hypertension from the medical care system.3 By examining BFFRS data, in a regularly collected sample representative of the healthrelated behaviors of all Americans, 25% of the >19,000 self-identified hypertensive citizens had not visited a physician in the past year. These folks were characterized by lack of insurance, low income, inadequate education, minority status, and barriers to access to medical care. The study population was defined by self-reported hypertension and thus probably underestimates the actual number of hypertensive persons without a link to medical care. Thus, one-fourth of these aware of their hypertension may have only encountered a sphygmomanometer in a setting that did not ensure progression to ongoing appropriate care. For these potential patients, the only impact of knowing (awareness) could be unrelieved anxiety. These aware but unconnected millions of Americans miss the opportunity to reduce their risk of stroke and heart attack. But, they may also be disadvantaged in their quality of life. There is evidence that these hypertensive persons are disadvantaged in both their occupational and private lives, when compared with treated and controlled confreres.2 Not surprisingly, this does not have to be.4 Fang also found that 90% of those eligible for Medicare had seen a physician within the past year.
1338 American Journal of Hypertension 27(11) November 2014
Presumably, access to medical care could have led to fewer strokes and heart attacks—and improved quality of life. Perhaps implementation of the Affordable Care Act (Obamacare) will narrow the gap between those who know of their need but lack appropriate service and those who have access and can attain effective antihypertensive treatment. Although this will not resolve the continuing failure of nearly half of even treated patients to achieve success, it would be an important step in the right direction.
References 1. Haynes RB, Sacket DL, Taylor DW, Gibson ES, Johnson AL. Increased absenteeism from work after detection and labeling of hypertensive patients. N Engl J Med 1978; 299:741–744. 2. Alderman MH, Charlson ME, Melcher LA. Labeling and absenteeism: the Massachusetts Mutual Experience. J Clin Invest Med 1981; 4:165–171. 3. Fang J, Yang Q, Ayala C, Loustalot F. Disparities in access to care among US adults with self-reported hypertension. Am J Hypertens 2014; 27:1377–1386. 4. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ, Sorlie PD, Sotoodehnia N, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation 2012;125:e2–220.
Downloaded from http://ajh.oxfordjournals.org/ at Universitaetsbibliothek Muenchen on November 5, 2014
The United States enjoys a somewhat dubious distinction among industrialized countries as the only nation without single-payer health insurance. The adverse consequences of this shortcoming are well documented. The extent to which this contributes to the fact that less than half of all American hypertensive persons achieve blood pressure control is well known.1 Less well recognized may be that aspects of our disjointed healthcare system may also actually cause harm.2 The 15% of Americans without health insurance are at particular risk of missing cardioprotective health services. Hypertension is asymptomatic. It tends to begin during the most productive and busy times in the lives of both men and women. Our fee-for-service system, by design, discourages routine, chronic, and poorly rewarded medical care, while raining vast sums on episodic procedure-oriented treatments. The great majority of those aged 40–60 years who feel well and are able to fully participate in the activities of ordinary life have little incentive to visit a physician.
Health Insurance, or Particularly Its Lack, and Healthcare Consequences Among Hypertensive Americans Michael H. Alderman1
Correspondence: Michael H. Alderman ([email protected]). 1Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York.
Initially submitted May 21, 2014; accepted for publication May 21, 2014. doi:10.1093/ajh/hpu128 © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: [email protected]
In this issue of the Journal, Fang and colleagues at the US Centers for Disease Control and Prevention have provided a window into the magnitude of the problem of dissociation of those who are aware of their hypertension from the medical care system.3 By examining BFFRS data, in a regularly collected sample representative of the healthrelated behaviors of all Americans, 25% of the >19,000 self-identified hypertensive citizens had not visited a physician in the past year. These folks were characterized by lack of insurance, low income, inadequate education, minority status, and barriers to access to medical care. The study population was defined by self-reported hypertension and thus probably underestimates the actual number of hypertensive persons without a link to medical care. Thus, one-fourth of these aware of their hypertension may have only encountered a sphygmomanometer in a setting that did not ensure progression to ongoing appropriate care. For these potential patients, the only impact of knowing (awareness) could be unrelieved anxiety. These aware but unconnected millions of Americans miss the opportunity to reduce their risk of stroke and heart attack. But, they may also be disadvantaged in their quality of life. There is evidence that these hypertensive persons are disadvantaged in both their occupational and private lives, when compared with treated and controlled confreres.2 Not surprisingly, this does not have to be.4 Fang also found that 90% of those eligible for Medicare had seen a physician within the past year.
1338 American Journal of Hypertension 27(11) November 2014
Presumably, access to medical care could have led to fewer strokes and heart attacks—and improved quality of life. Perhaps implementation of the Affordable Care Act (Obamacare) will narrow the gap between those who know of their need but lack appropriate service and those who have access and can attain effective antihypertensive treatment. Although this will not resolve the continuing failure of nearly half of even treated patients to achieve success, it would be an important step in the right direction.
References 1. Haynes RB, Sacket DL, Taylor DW, Gibson ES, Johnson AL. Increased absenteeism from work after detection and labeling of hypertensive patients. N Engl J Med 1978; 299:741–744. 2. Alderman MH, Charlson ME, Melcher LA. Labeling and absenteeism: the Massachusetts Mutual Experience. J Clin Invest Med 1981; 4:165–171. 3. Fang J, Yang Q, Ayala C, Loustalot F. Disparities in access to care among US adults with self-reported hypertension. Am J Hypertens 2014; 27:1377–1386. 4. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ, Sorlie PD, Sotoodehnia N, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation 2012;125:e2–220.
Downloaded from http://ajh.oxfordjournals.org/ at Universitaetsbibliothek Muenchen on November 5, 2014
The United States enjoys a somewhat dubious distinction among industrialized countries as the only nation without single-payer health insurance. The adverse consequences of this shortcoming are well documented. The extent to which this contributes to the fact that less than half of all American hypertensive persons achieve blood pressure control is well known.1 Less well recognized may be that aspects of our disjointed healthcare system may also actually cause harm.2 The 15% of Americans without health insurance are at particular risk of missing cardioprotective health services. Hypertension is asymptomatic. It tends to begin during the most productive and busy times in the lives of both men and women. Our fee-for-service system, by design, discourages routine, chronic, and poorly rewarded medical care, while raining vast sums on episodic procedure-oriented treatments. The great majority of those aged 40–60 years who feel well and are able to fully participate in the activities of ordinary life have little incentive to visit a physician.
