A. R. Scott1,3, A. J. Rush1, C. J. Balentine2, D. H. Berger1,3, A. D. Naik1,3, J. W. Suliburk1 1Baylor College Of Medicine,Houston, TX, USA 2University Of Wisconsin,Madison, WI, USA 3VA Center For Innovations In Quality, Effectiveness And Safety,Houston, TX, USA
Introduction:
Surgical diseases and their treatment have a significant economic impact. Costs associated with surgery are frequently studied at the system level, but reports of the costs for individual patients are less common. The price a patient pays for a surgical intervention and the surrounding care includes not only fees recognized by the healthcare system, but also patient-centered costs including travel, childcare, and lost wages. We hypothesized that the patient-centered costs of routine postoperative clinic visits disproportionately impact patients with low incomes.
Methods:
This was a cross-sectional study performed in the acute care surgical follow-up clinic at an urban level 1 trauma center which serves as the county safety net hospital. In January and February 2014, a survey covering social, demographic, and financial topics was collected from patients undergoing follow up for appendectomy, cholecystectomy, and surgical treatment of soft tissue infections, which represent approximately 30% of the patients seen in our facility. The patient-centered cost was calculated from these surveys as the sum of the costs of transportation, childcare, and lost wages. Costs were compared between patients whose annual income was less than 50% of the Federal Poverty Level (FPL), 50-100% FPL, 100-200% FPL, and more than 200% FPL. The Kruskal-Wallis test was used to compare groups and then post-hoc analysis performed using the Wilcoxon rank-sum with Bonferroni correction.
Results:
Surveys response rate was >90% with a total of 97 surveys collected; 59 contained all data needed for cost calculations. The median patient-centered cost of a clinic visit was $27 (IQR $20-$62). Components of this cost were $16 ($14-$20) for travel, $22 ($20-$50) for childcare in patients requiring childcare, and $0 ($0-$30) in lost wages. No significant differences (p = 0.95) in cost were seen between patients in the four income groups (Table 1). When the patient-centered costs as a percentage of monthly income were compared, however, significant differences (p < 0.001) were seen (Table 1). No significant differences were present between the three higher income groups.
Conclusion:
The patient-centered cost of a routine postoperative clinic visit can be a significant burden. Consistent with our hypothesis, the lowest income patients are disproportionately impacted, spending more than 6% of their monthly income on costs associated with the clinic visit. Efforts of cost containment should focus not just on system costs, but also patient-centered costs. Future studies should examine alternative, lower cost methods of follow up for low-risk surgeries in an effort to reduce their financial burden.
