Abstract

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.SUMMARY 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 two-part model using a logistic regression and a generalized linear model with gamma distribution and log link was used to evaluate 12-month out-of-pocket costs after traumatic injury. Multivariable logistic regression was used to evaluate the likelihood of catastrophic health expenditure 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 $1,703 in 12-month OOPC after trauma, compared to those covered by traditional health plans. In addition to HDHP enrollment, worsening injury severity and longer hospital stays were also associated with increased 12-month OOPC after trauma. Non-white minorities paid less 12-month OOPC after trauma compared to non-Hispanic white patients, but also used fewer services. Overall, the incidence of CHE was 5%; however high-deductible health plan enrollees faced a 13% chance of CHE.CONCLUSIONS: Privately insured trauma patients face substantial out-of-pocket costs at the time of their injuries. High-deductible health plans are associated with increased financial vulnerability after trauma.

View details for DOI 10.1097/SLA.0000000000005225

View details for PubMedID 34596072