Heart Attack Care Often Delayed for the Poor

[AlphaCentauri]

Source: WP

Poorer Americans, including those on Medicaid, are more likely to take much longer to get to the hospital when a heart attack strikes compared to more affluent people, a new study finds.

The finding suggests that patients without means may be at a greater risk of missing a critical window for time-sensitive care following a heart attack, the researchers noted.

"It's so important to get to the hospital quickly when a patient feels they are having symptoms of a heart attack," noted study lead author Randi E. Foraker, a doctoral candidate in the department of epidemiology at the University of North Carolina, Chapel Hill. "So it was particularly concerning to us that patients from lower socio-economic status areas, and patients covered by Medicaid insurance, experienced more of a pre-hospital delay in getting to a health facility."

Foraker and her team published their findings in the Sept. 22 issue of theArchives of Internal Medicine.
Their conclusions stem from an analysis of more than 6,700 medical records of men and women who experienced a heart attack between 1993 and 2002. By matching patient addresses to 2000 U.S. census data, the research team was able to establish household income levels as either low (less than $33,533), medium (between $33,533 and $50,031) or high (over $50,032).



Read more: http://www.washingtonpost.com/wp-dyn/content/article/2008/09/22/AR2008092202368.html

[rpannier]

1. Thank goodness the US doesn't have national health care

Otherwise you'd be waiting in line to see a doctor instead of

stepping over the bodies of the poor who died from lack of proper medical care

[elias7]

4. the article states that lack of insurance didn't affect wait times

"They noted that one factor -- a lack of health insurance -- didn't seem to affect wait times."

Also, "For example, patients residing in lower-income neighborhoods were 46 percent more likely to experience a long rather than a short delay in getting to a hospital after heart attack, the study found. And patients on Medicaid were 87 percent more likely to wait a long time before having their symptoms seen to, the team reported."

This may be that lower SES folks may wait longer to seek care. Also suggested is that ambulance services may not be as abundant in certain areas. Not saying that national health care isn't desirable, but there is a suggestion that having or not having insurance may not be the prime variable in seeking care.

[prolesunited]

8. Even if you have health insurance

you are still stuck with co-pays of 20 to 30 percent -- doable for somebody with some money, not so much for those who are scraping by. It makes you think twice.

Also, to avoid ER abuse, many policies have changed the way they pay for ER visits, upping co-pays to $100 or sticking you with 50% of the bill if you aren't admitted. So, you break a leg and can't get in to see your doctor immediately. You have a huge bill since you won't be admitted to the hospital for that but it does need immediate treatment. Even people with insurance these days are getting the shaft.

Heck, I have insurance and messed up my knee and I'm just playing the waiting game since I'm pretty sure it's just a ligament strain. I can't afford the co-pays for a visit and an MRI right now.

[rpannier]

11. former President George Bush said in 1991

"Sure we could insure everyone. But then people would have to wait in long lines to see a doctor."

That was his justification for opposing National Health Care.
That's the root of my comment about long lines.

[Benhurst]

2. How's Reaganomics working for you, America?

Ready yet for the Reagan Revolution?

[Solly Mack]

3. K&R

[area51]

5. Healthcare

The way our healthcare delivery system works, is it's a form of population control for the U.S. It makes sure to kill off 100,000 Americans every year.

[AlphaCentauri]

6. Good article a must to read n/t

[Fire_Medic_Dave]

7. I hope the actual thesis has more conclusions and suggestions.

[happyslug]

9. Could this be tied in with the limitation on assets i.e $2000

Under Federal Transitional Aid to Needy Families (TANF) total assets must be less than $2000. Most states for people on Welfare (And this on Medicaid) is less, in Pennsylvania $300 (Through Food Stamps, being a Federal Program, uses $2000 as the assets limit. Please note we are talking about TOTAL ASSETS, beds, sofas, chairs, Ovens, etc in addition to and including Automobiles.

Remember we are talking Medicaid not Medicare. Medicaid is medical assistance for the poor. To be eligible you AND your family (which is defined as EVERYONE living in the same house) must have less then $2000 in assets (and some states less). Furthermore Income for the person's "family" must also be below certain thresholds. If someone is on Supplemental Security Income (SSI, 100% federally funded) that person is on Medicare, but if a person is NOT on SSI, then the income guidelines tend to be much lower. In my home state the Income has to be below whatever is the welfare grant for that family ($174 for a family in one, $265 for a Family of Two, $87 for each additional member, my state varies Welfare grant by County, my County the limit is $174 for one person, in Philadelphia it is $226, in Pittsburgh $206). Thus many people on Medicaid have this low income.

People can work and still get welfare, but for every $1 you earn working you lose 50 cents in Income. Thus Maximum income before you lose your welfare grant is an additional $87 per month (i.e. for a family of one max income of $261 per month (and under Welfare reform, someone in the family MUST be under 18, you looking at a minimum of a family of two for $265 per month Welfare Grant, and if working no more then $397.50 per month.

Now my state has a "Spend Down" program that permits people who earn more then $174 to get Medicaid, but only after they have paid the equivalent of the difference between their net monthly income and what they would get on Welfare, then Medicaid will pay the rest (Income $1000, if th person PAYS $826 in Medical costs that month the state will pick up the rest).

My point is that most people on Medicaid have low access to money. Many do NOT own a Car, many do not even have phones. Thus if something happens to them they have to go to a neighbor to use a phone or to use a phone. Prior to about the late 1990s the biggest demand of low income communities as more pay phones, so they could use them as needed (but the phone companies did not want to install them do to increase damage to the phone and low use except for emergency calls which which tended NOT to justify the Pay Phones, then with increase drug use in the 1990s Pay Phones started to be used by Drug dealers, which caused a push to pull them out, even as more and more people did NOT have phone service themselves). Today, Pay phones are rare, Cell Phones put most of them out of business. Pay Phones are even rarer in poor communities do to the addition problem of drug dealers using them (And to drug addicts breaking into them for money for drugs), Thus it is a lot harder for people on Medicaid to MAKE a phone call.

This is made more difficult by the Welfare restriction as to Assets. In fact this restriction was so bad that Congress had to address it in the Welfare Reforms of the mid 1990s. Most states had limits to assets so low that the only cars the poor could own were unreliable junk. Even in the 1990s a used car that would be a good steady form of transportation to get to one's job in the Suburbs cost about $2000. If you purchased a Car below that figure it probably did not run, or if it did run not to long. Thus if someone was in a Welfare To Work Program that program could include purchase of a car. Limitation as to amounts were quite low, but higher then many states assets limitations.

My point is simple, the reason Medicaid persons take longer to get treated is that it takes longer for them to get to a phone or to a car to get treated. These have to do with being poor and how we ignore the poor more then the lack of access to Medical treatment once in a hospital.

[Quantess]

10. Why is this in LBN? It isn't news.

This isn't anything people didn't know already.

(of course this belongs in LBN)

[ManiacJoe]

12. A reasonable guess on why.

From the article:

"As to why this might be so, it seems to me that there is a sort of mystery component to any relationship between income and delay," said Dr. Marshall Morgan, chief of emergency medicine at the Ronald Reagan UCLA Medical Center in Los Angeles. "Recognizing symptoms is key, and I could suggest that although there has been more of an effort in recent years to educate the public about heart attack symptom recognition, this campaign may have penetrated well among the better-educated and less well among the less well-educated. And, of course, there's no question that economic status and education go together"