Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT.
Am Heart J. 2021 Aug;238:75-84. doi: 10.1016/j.ahj.2021.04.011. Epub 2021 May 5.
Cardiovascular disease (CVD) is a major source of financial burden and distress, which has 3 main domains: (1) psychological distress; (2) cost-related care non-adherence or medical care deferral, and (3) tradeoffs with basic non-medical needs. We propose 4 ways to reduce financial distress in CVD: (1) policymakers can expand insurance coverage and curtail underinsurance; (2) health systems can limit expenditure on low-benefit, high-cost treatments while developing services for high-risk individuals; (3) physicians can engage in shared-decision-making for high-cost interventions, and (4) community-based initiatives can support patients with system navigation and financial coping. Avenues for research include (1) analysis of how healthcare policies affect financial burden; (2) comparative effectiveness studies examining high and low-cost strategies for CVD management; and (3) studying interventions to reduce financial burden, financial coaching, and community health worker integration.
心血管疾病（CVD）是经济负担和痛苦的主要来源，有 3 个主要领域：（1）心理困扰；（2）与费用相关的护理不遵守或医疗护理延迟；（3）与基本非医疗需求的权衡。我们提出了 4 种减轻 CVD 患者经济负担的方法：（1）政策制定者可以扩大保险覆盖范围并减少保险不足；（2）卫生系统可以限制低效益、高成本治疗的支出，同时为高风险个体开发服务；（3）医生可以参与高成本干预措施的共同决策；（4）社区倡议可以为患者提供系统导航和财务应对支持。研究途径包括：（1）分析医疗保健政策如何影响经济负担；（2）比较研究高成本和低成本 CVD 管理策略的效果；（3）研究减轻经济负担的干预措施、财务指导以及社区卫生工作者的整合。
