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Citation
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Nishtala MV, Reed M, Schumacher J, Hanlon B, Venkatesh M, Collins M, Zarzaur BL. J. Trauma Acute Care Surg. 2023; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: Motor Vehicle Crashes are a leading cause of non-fatal injury in the United States and impose a high financial cost to the patient and the economy. For many patients, this cost may be financially devastating and contribute to worsening health outcomes after injury. We aimed to describe the population level risk of catastrophic health expenditure (CHE) and determine factors associated with risk of CHE.
METHODS: We performed a retrospective review using the 2014-2017 Nationwide Inpatient Sample. The study population consisted of uninsured and privately insured adults 26-64 who were hospitalized for non-neurologic traumatic injury due to Motor Vehicle Crashes. Our measure of financial hardship was Catastrophic Health Expenditure, which was defined as hospital charges ≥40% of post-subsistence income. Income estimates were derived from zip-code level data using Gamma distribution Modeling.
RESULTS: Our sample included 189,000 patients, of which 149,705 had private insurance and 39,375 were uninsured. Median estimated income for the study cohort was $66,118 (IQR: 65, 353-$66,884). Median cost of hospitalization was $53,467 (IQR: $29,854-$99,914). 91.5% of uninsured patients suffering from MVC are at risk for CHE. 10.1% of privately insured patients are at risk for CHE. Amongst the insured, Black, Hispanic, and low income were associated with CHE.
CONCLUSIONS: 9 out of 10 uninsured patients are at risk for CHE after hospitalization for motor vehicle crash. Despite having insurance, 10% of patients are still at risk of CHE. Black, Hispanic, and low-income communities are at highest risk of having private insurance and still experiencing CHE. This is the first population level analysis after the implementation of the Affordable Care Act that assesses the financial burden of no insurance and underinsurance. This data are important to understand the effectiveness of insurance coverage and guide hospital and policy level interventions to prevent CHE. LEVEL OF EVIDENCE: Prognostic/Epidemiological, Level III.
Language: en |