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Hospital care frequently saves patients from gunshots, stab wounds,
crushing car accidents and other traumatic injuries. But Scott found
in a new study that 7 out of 10 adult uninsured trauma patients
suffer another debilitating injury: financial catastrophe.
“We’re getting better at trauma, and they’re going home financially
ruined,” Scott said in a phone interview.
“Everyone in America’s at risk for an accidental injury, and not
everyone’s protected from the financial consequences,” said Scott,
lead author of the study and a surgery resident at Brigham and
Women’s Hospital in Boston.
The study, reported in Annals of Surgery, is the first to couple
data on U.S. trauma admissions with Census Bureau data on income to
evaluate the risks of catastrophic health expenses.
Researchers analyzed 117,502 hospital admissions for uninsured 18-
to 64-year-olds admitted for trauma care from 2007 to 2011, before
implementation of the Affordable Care Act.
Overall, half the patients had an estimated annual income below
$40,867, and half had hospital charges of at least $27,420, not
counting charges from doctors, who bill separately.
In other words, one unforeseen major injury could potentially cost
well over half of someone’s annual income.
Previous studies have examined the impact of hospitalizations on
so-called medical bankruptcies. But most who file for bankruptcy in
the aftermath of medical crises are middle-class Americans with
health insurance, the authors write, while the poorest uninsured
often never declare bankruptcy.
To capture poorer uninsured Americans, Scott used the “catastrophic
health expenditure” metric, which the World Health Organization uses
to compare out-of-pocket expenses to income.
Scott defined catastrophic health spending as out-of-pocket health
costs that were more than 40 percent of a patient’s income after
they paid for food.
By that definition, nearly 71 percent of uninsured 18- to
64-year-old trauma patients - or more than 82,000 men and women -
risk financial calamity every year.
Patients with the lowest incomes were at highest risk - 78 percent -
of destitution. But even those with the highest incomes had a 53
percent risk of a medically induced fiscal catastrophe, the study
found.
Dr. David Himmelstein, a professor at the City University of New
York’s Hunter College School of Public Health, described the study
as “quite sophisticated.” It “paints an extraordinarily disturbing
picture of America’s vulnerability,” he said in an email.
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“This study shows that someone who is in a car accident, or is
mugged, or experiences sudden trauma for some other reason, risks
being driven to financial ruin,” he added.
“In essence, unless you’re Bill Gates, you could be at risk of
financial catastrophe if you fall seriously ill,” said Himmelstein,
who was not involved with the study.
The uninsured are not the only ones suffering the consequences of
catastrophic health expenditures, Scott said. When hospitals fail to
collect, they pass the costs onto paying customers and
health-insurance companies, he said.
“More uncompensated care leads to higher costs for everybody else,”
he said.
“For clinicians, it’s important to consider the financial strain as
a complication of trauma care. Survival is not the only measure of
good care,” he said.
But when a patient asks him how much a CT scan will cost, he has no
idea.
Scott’s message to lawmakers considering changes to the Affordable
Care Act: “Financial catastrophe is a reality for tens of thousands
of Americans who haven’t planned for it. They’re being cured, but
being cured into destitution.”
“There’s nobody we turn away for emergency trauma care. We don’t
check people’s insurance status. We don’t check their wallet,” he
said. “If everybody is deserving of world-class trauma care,
everybody is deserving of protection from financial catastrophe from
that care.”
SOURCE: http://bit.ly/2oUGABo Annals of Surgery, online April 7,
2017.
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