Catastrophic expenditures in California trauma patients after the Affordable Care Act: reduced financial risk and racial disparities

Liu, Charles; Rahman, Arifeen S.; Chao, Tiffany E.

doi:10.1016/j.amjsurg.2020.04.012

Cited by 24 publications

(24 citation statements)

References 19 publications

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“…28 Lower income groups and racial minorities experienced the largest decrease in OOPC, indicating that gaining insurance lowers overall OOPC. 34 Yet despite protections such as private insurance, certain groups within our study still faced elevated risk of CHE, particularly HDHP enrollees, and women, older patients, and those with less education. Indeed, high-deductible health plans may erode the protective effects of insurance.…”

Section: Discussionmentioning

confidence: 79%

Financial Burden of Traumatic Injury Amongst the Privately Insured

Arnow

Trickey

et al. 2021

Annals of Surgery

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Objective: We sought to evaluate the overall financial burden associated with traumatic injury amongst patients with private insurance and assess the effect of high deductible plans on out-of-pocket costs (OOPCs). Summary of Background Data: Traumatic injury can be a source of unexpected financial burden for households. However, the effect of increasing participation in higher cost-sharing private health insurance plans remains unknown. Methods: We conducted a retrospective cohort observational study, using the Clinformatics Data Mart Database, a nationwide single-payer administrative claims database to identify US adults who required emergency department services or hospital admission for single traumatic injury from 2008 to 2018. A 2-part model using a logistic regression and a generalized linear model with gamma distribution and log link was used to evaluate 12-month OOPCs after traumatic injury. Multivariable logistic regression was used to evaluate the likelihood of catastrophic health expenditure (CHE) after injury. Results: Of 426,945 included patients, 53% were male, 71% were white, and median age was 42 years. Patients faced monthly OOPC of $660 at the time of their injury. High deductible plan enrollment was associated with an increase of $1703 in 12-month OOPC after trauma, compared to those covered by traditional health plans. In addition to high deductible health plan enrollment, worsening injury severity and longer hospital stays were also associated with increased 12-month OOPC after trauma. Non-white minorities paid less 12month OOPC after trauma compared to non-Hispanic white patients, but also used fewer services. Overall, the incidence of CHE was 5%; however highdeductible health plan enrollees faced a 13% chance of CHE. Conclusions: Privately insured trauma patients face substantial OOPCs at the time of their injuries. High-deductible health plans are associated with increased financial vulnerability after trauma.

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Section: Discussionmentioning

confidence: 79%

Financial Burden of Traumatic Injury Amongst the Privately Insured

Arnow

Trickey

et al. 2021

Annals of Surgery

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“…The implementation of the ACA has been shown to improve the accessibility, affordability, and quality of health care and has substantially reduced the number of uninsured Americans 15 . One study found that there was a 74% decrease in the odds of CHEs associated with ACA implementation, as well as a decrease in racial and ethnic disparities in the likelihood of catastrophic spending 3 . Another study found that large gains in insurance coverage were associated with equivalent-sized gains in financial risk protection 7 .…”

Section: Discussionmentioning

confidence: 99%

Catastrophic Health Expenditure in Patients with Lower-Extremity Orthopaedic Trauma

Law

Brody

Cavanaugh

et al. 2022

Journal of Bone and Joint Surgery

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Background:Health-care expenditures are a leading contributor to financial hardship in the United States. Traumatic orthopaedic injuries are unpredictable and result in substantial expense. Our objectives were to quantify the catastrophic health expenditure (CHE) risk of patients with orthopaedic trauma and to examine the impact of insurance status, socioeconomic status, sex, and race on CHE.Methods:We identified all isolated lower-extremity orthopaedic trauma cases at a safety-net, Level-1 trauma center from 2018 to 2020. We queried an institutional charge database to obtain total hospital charges, insurance status, and ZIP Code to determine out-of-pocket (OOP) expenditures. To evaluate financial hardship, we calculated the CHE risk as defined by the World Health Organization’s threshold of OOP expenditures, ≥40% of estimated household post-subsistence income.Results:In our cohort of 2,535 patients, 33% experienced a risk of CHE. A risk of CHE was experienced by 99% of patients who were uninsured, 35% of patients with private insurance, 2% of patients with Medicare, and 0% of patients with Medicaid. Multivariable regression modeling showed that patients who were uninsured were significantly more likely to experience a risk of CHE compared with patients with private insurance (odds ratio, 107.68 [95% confidence interval, 37.20 to 311.68]; p < 0.001).Conclusions:One-third of patients with lower-extremity orthopaedic trauma experience a risk of CHE, with patients who are uninsured facing a disproportionately higher risk of CHE compared with patients who are insured. Our results suggest that the expansion of public insurance options may provide substantial financial protection for those at the greatest risk for CHE.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…Beyond the statistical significance of the Medicaid gap, we are further aware that the deep root of the decline of the Medicaid expansion is not just about financial limits, but also about the political contest. We called it the “Politics of Medicaid”, which means democratic states asserting Medicaid importance while republic states are holding Medicaid cuts [ 50 ]. When standing at marginal in a polity, the Medicaid gap has to stop to think about how policy and political vulnerability [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

Predict Health Care Accessibility for Texas Medicaid Gap

Zhang

2021

Healthcare

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Medicaid is a unique approach in ensuring the below poverty population obtains free insurance coverage under federal and state provisions in the United States. Twelve states without expanded Medicaid caused two million people who were under the poverty line into health insecurity. Principal Component-based logistical regression (PCA-LA) is used to consider health status (HS) as a dependent variable and fourteen social-economic indexes as independent variables. Four composite components incorporated health conditions (i.e., “no regular source of care” (NRC), “last check-up more than a year ago” (LCT)), demographic impacts (i.e., four categorized adults (AS)), education (ED), and marital status (MS). Compared to the unadjusted LA, direct adjusted LA, and PCA-unadjusted LA three methods, the PCA-LA approach exhibited objective and reasonable outcomes in presenting an odd ratio (OR). They included that health condition is positively significant to HS due to beyond one OR, and negatively significant to ED, AS, and MS. This paper provided quantitative evidence for the Medicaid gap in Texas to extend Medicaid, exposed healthcare geographical inequity, offered a sight for the Centers for Disease Control and Prevention (CDC) to improve the Medicaid program and make political justice for the Medicaid gap.

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Catastrophic expenditures in California trauma patients after the Affordable Care Act: reduced financial risk and racial disparities

Cited by 24 publications

References 19 publications

Financial Burden of Traumatic Injury Amongst the Privately Insured

Financial Burden of Traumatic Injury Amongst the Privately Insured

Catastrophic Health Expenditure in Patients with Lower-Extremity Orthopaedic Trauma

Predict Health Care Accessibility for Texas Medicaid Gap

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