K. M. O’Neill3, R. A. Jean3, C. P. Gross2, R. D. Becher3, R. Khera4, J. V. Elizondo5, K. Nasir2 2Yale University School Of Medicine,Internal Medicine,New Haven, CT, USA 3Yale University School Of Medicine,General Surgery,New Haven, CT, USA 4University Of Texas Southwestern Medical Center,Cardiology,Dallas, TX, USA 5Yale University School Of Medicine,New Haven, CT, USA
Introduction: Trauma-related disorders rank among the top-five most costly medical conditions to the healthcare system. However, the impact of healthcare expenses on the families of patients suffering traumatic injury is not well studied. To address this gap in knowledge, we used nationally representative data to investigate the burden of financial hardship from out-of-pocket (OOP) health expenses for families with one or more members suffering from a traumatic injury, specifically evaluating the role of socioeconomic status and injury severity on financial burden.
Methods: This retrospective cross-sectional study used nationally representative Medical Expenditure Panel Survey data from 2010 through 2015. We identified families in which at least one member had a traumatic injury and classified this injury based on severity; socioeconomic status was based on family income. Percent of annual family income used for OOP health expenses was used to assess for the risk of excess financial burden (OOP>20% of annual income) and catastrophic medical expenses (OOP>40% of annual income) adjusting for demographic, socioeconomic, and healthcare utilization factors in a multivariable logistic regression model.
Results: We identified 7,538 individuals with injuries, represented in 7,102 families of the total 90,964 families in the cohort. Of these, 668 families were classified as severe. Families with a severe traumatic injury experienced increased OOP medical expenses, spending on average $2,784 (95% CI: $2,106-$2833). Increased severity of injury was also associated with increased proportion of excess final burden. Overall 4.4% in the uninjured cohort experienced excess financial burden, compared to 5.6% of families with a minor injury and 12.6% of families with severe injury (see Figure). In a risk-adjusted logistic regression model, families with a severe injury were significantly more likely to experience excess financial burden (OR: 2.04, 95% CI: 1.13-3.64) and catastrophic medical expenses (OR: 3.08, 95% CI: 1.37-6.9). Families below the federal poverty line had increased odds of excess financial burden (OR: 18.1, 95% CI: 15.3-21.4) and catastrophic medical expenses (OR: 47.8, 95%CI: 35.5-64.7).
Conclusions: Approximately 1 in 8 households with a severely injured family member experience financial hardship. These families are significantly more vulnerable to incurring catastrophic OOP health expenses than the non-injured population. This effect was most pronounced for families living below the poverty line. These results highlight the vulnerability of poor families to financial hardship from OOP expenses and reinforce the importance of injury prevention strategies.
