Inequalities in stroke treatment: health insurance coverage does matter

All people are created equal. So why don’t people get equal treatment when it comes to stroke? Does it have something to do with health insurance coverage?

Ischemic stroke occurs when a blood clot blocks a blood vessel supplying blood to the train. The cutting off of the blood supply (and therefore oxygen) of the brain can lead to death of brain cells which can in turn cause permanent damage. Ischemic stroke is the most common type of stroke and is a major cause of disability.

The state of the art in the treatment of ischemic stroke is the tissue plasminogen activator (tPA). tPA is a thrombolytic or clot-busting agent and is the only drug of its kind which has been approved by the US FDA for the emergency treatment of acute ischemic stroke. It is also a time-critical type of treatment and should be given within 3 hours after the onset of stroke symptoms to be effective. Recent studies even suggest that tPA can still reverse the neurological effects of stroke and prevent death and disability when given up to 4.5 hours after the onset of stroke.

However, a recent study funded by the U.S. Centers for Disease Control and Prevention (CDC) showed that “between July 1, 2005 and June 30, 2007, the tPA treatment national average was 2.4 percent of all ischemic stroke patients in the Medicare database.” Reports of rates of tPA administration in hospitals all over the US range from 0 to 24%. The rate of 2.4% among Medicare patients is seemingly low. In addition, 64% of all hospitals in the US did not administer clot busters to Medicare stroke patients during this time period.

According to a Dr. Lee Schwamm, an associated professor of Neurology at Harvard University

“This study sheds important light on a major disparity in acute stroke care delivery…Individuals and agencies responsible for the equitable distribution of healthcare resources need to examine these and other data to identify strategies that will provide adequate acute stroke care to all their citizens.”

There are of course other factors to consider, including the size of the hospitals in question, as well as their geographical location. A previous study on emergency care of stroke victims also found that the following factors can make a difference in the kind of treatment received:

• the type of hospital (does it have a Primary Stroke Center?)
• the manner of patient arrival/delivery (walk in vs. ambulance delivery)
• gender (men get treated faster!)

The issue of health insurance coverage is a major issue in the US.  Read more about the “crisis of the uninsured” in a previous post.