Health Care Costs May Limit Treatment for Hypertensive Patients

A review of 53 studies finds that hypertension patients with health insurance were more likely to be adherent to antihypertensive medication and to have their hypertension under control than were those without insurance.

Hypertension patients with insurance and low co-payments are more likely to have control over their blood pressure and adhere to their medications than are uninsured patients who pay more for their medicine, according to the results of a systematic review.

The review, published in the July 2013 issue of PLOS Medicine, is the first to investigate the effect that regional and national interventions, such as health policies and programs, have on hypertension outcomes. The researchers analyzed 53 studies (controlled, cohort, and cross-sectional) on the effects of national and regional health system factors, interventions, policies, and programs on hypertension awareness, treatment, and medication adherence.

Most studies included were conducted in the United States, and 38 focused on the relationship between health care financing and hypertension control. Out of 21 studies assessing health insurance coverage, 20 were conducted in the United States, and 1 was conducted in Mexico. A 9-year cohort study found that uninsured patients were less likely to be aware that they had hypertension and to have their hypertension under control than were insured patients. Another cohort study found that insured hypertension patients were more likely to be adherent to their medications than were uninsured patients. Of 15 cross-sectional studies that compared hypertension outcomes in insured and uninsured patients, 8 reported that insured patients were more likely to be adherent and have controlled hypertension than were those without insurance.

Of 14 studies evaluating the association of co-payments and medication costs with hypertension control, treatment, or adherence, 9 were conducted in the United States and the rest were conducted in Cameroon, China, Finland, Israel, and Brazil. Half of these were cohort studies, all of which found a link between increased medication costs or co-payments and decreased hypertension control or decreased adherence to antihypertensive medication.

A total of 6 cross-sectional studies conducted in the United States analyzed the effect of a consistent place of care for hypertension on patient outcomes. All but 1 of these studies reported a relationship between a routine place of care and improved hypertension awareness, treatment, or control. Similar results were found in 6 of 7 studies assessing the relationship between being routinely treated by 1 physician and having one’s hypertension under control.

These findings suggest that health care and medication costs may limit the care patients with hypertension receive in the United States, the researchers note.

“On balance, we found health insurance coverage to be associated with improved outcomes of [hypertension] care in US settings, suggesting that expanded insurance coverage through The Patient Protection and Affordable Care Act (also known as Obamacare) may improve [hypertension] outcomes,” the researchers write.

Although most of the studies covered in the review were conducted in the United States, the researchers suggest their findings may be applicable to other countries as well. However, more research is still needed to evaluate the impact of interventions in other nations.

“Ultimately, an increase in the number of high quality, longitudinal and randomized studies identifying and analyzing the effect of health system arrangements on [hypertension] care is required, particularly in [low- or middle-income countries] where the majority of the global burden of [hypertension] lies, and where weaknesses in health systems are thought to play a significant role in deficiencies in chronic disease care,” the researchers conclude.