Healthcare Utilization and Associated Time and Out-of-Pocket Expenditures for Cardiovascular Disease Patients in a Publicly-Funded Healthcare System
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Background: The objectives of this study were to describe: (1) healthcare utilization and associated patient time and out-of-pocket costs (OOP) over 2 years following a cardiac diagnosis, (2) the sociodemographic and clinical drivers of these costs, and (3) patient costs related to cardiac rehabilitation (CR) participation. Methods: Secondary analysis was conducted on an observational, prospective CR program evaluation cohort in Ontario which has a publicly-funded healthcare system. A convenience sample of patients from one of 3 CR programs was approached at their first visit, and consenting participants completed a survey. Participants were emailed surveys again 6 months, 1 and 2 years later; these assessed their cardiac care and medications, and the time and OOP costs associated with care visits. Patient time was valued based on average wages in Ontario. Results: Of 411 consenting patients, 240 (58.3%) completed CR, and 192(46.7%) were retained at 2 years. Patients most often had visits to their general practitioner, electrocardiograms, and treatment for angina. The total cost to patients over2 years was $73.70±275.84for time and $377.01±321.72forOOP costs($525.93±467.08 overall). With adjustment, there were significantly higher OOP costs for females(p<.001), and less educated(p<.001) patients. Participants spent considerable money relatively OOP on CR visits alone ($384.78±269.67), with time costs at $379.07±1035.49($939.43±1333.29 overall; 1.6% share of 1 year’s income). Conclusions: In conclusion, time and OOP costs are modest for cardiac patients, except for CR. Alternative delivery models are needed, in particular for low-income patients.
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