Financial Hardship After Traumatic Injury: Risk Factors and Drivers of Out-of-Pocket Health Expenses

Background Trauma-related disorders rank among the top five most costly medical conditions to the health care system. However, the impact of out-of-pocket (OOP) health expenses for traumatic conditions is not known. In this cross-sectional study, we use nationally representative data to investigate whether patients with a traumatic injury experienced financial hardship from OOP health expenses. Methods Using data from the Medical Expenditure Panel Survey from 2010 to 2015, we analyzed the financial burden associated with a traumatic injury. Primary outcomes were excess financial burden (OOP>20% of annual income) and catastrophic medical expenses (OOP>40% of annual income). A multivariable logistic regression analysis evaluated whether these outcomes were associated with traumatic injury, adjusting for demographic, socioeconomic, and health care factors. We then completed a descriptive analysis to elucidate drivers of total OOP expenses. Results Of the 90,964 families in the cohort, 6434 families had a traumatic injury requiring a visit to the emergency room and 668 families had a traumatic injury requiring hospitalization. Overall 1 in 8 households with an injured family member requiring hospitalization experienced financial hardship. These families were 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). The largest burden of OOP expenses was due to prescription drug costs, with inpatient costs as a major driver of OOP expenses for those requiring hospitalization. Conclusions Households with an injured family member requiring hospitalization are significantly more vulnerable to financial hardship from OOP health expenses than the noninjured population. Prescription drug and inpatient costs were the most significant drivers of OOP health expenses.

背景 与创伤相关的疾病在医疗保健系统中属于成本最高的五类疾病之一。然而，创伤性疾病的自付医疗费用的影响尚不明确。在这项横断面研究中，我们使用具有全国代表性的数据来调查创伤性损伤患者是否因自付医疗费用而经历经济困难。 方法 利用2010年至2015年医疗支出面板调查的数据，我们分析了与创伤性损伤相关的经济负担。主要结果是过高经济负担（自付费用>年收入的20%）和灾难性医疗费用（自付费用>年收入的40%）。一项多变量逻辑回归分析评估了这些结果是否与创伤性损伤相关，并对人口统计学、社会经济和医疗保健因素进行了调整。然后我们完成了一项描述性分析以阐明自付总费用的驱动因素。 结果 在该队列的90964个家庭中，6434个家庭有需要去急诊室就诊的创伤性损伤，668个家庭有需要住院治疗的创伤性损伤。总体而言，在有需要住院的受伤家庭成员的家庭中，八分之一经历了经济困难。这些家庭更有可能经历过高经济负担（比值比：2.04，95%置信区间：1.13 - 3.64）和灾难性医疗费用（比值比：3.08，95%置信区间：1.37 - 6.9）。自付费用的最大负担来自处方药费用，对于需要住院的患者，住院费用是自付费用的主要驱动因素。 结论 有需要住院的受伤家庭成员的家庭比未受伤人群更容易因自付医疗费用而遭受经济困难。处方药和住院费用是自付医疗费用的最重要驱动因素。