In Reply: In contrast to the assertion of Drs van Riezen and de Jonge of a treatment-risk paradox in our findings, we would note that the treatment-risk paradox refers to a pattern in which physicians paradoxically apply therapies to patients with the least potential to benefit and less often apply therapies to those with the most opportunity to benefit.1 Instead, we have documented a patient behavior associated with insurance status and likelihood of presenting promptly for care of an AMI. Our concern is the implication of insurance status and potential disparities in access to care.
Smolderen KG, Spertus JA, Chan PS. Insurance and Financial Concerns Among Patients Seeking Care for Acute Myocardial Infarction—Reply. JAMA. 2010;304(5):523-524. doi:10.1001/jama.2010.1071