PC42. The Epidemiology of Postoperative Catastrophic Health Expenditure in The United States

Abstract

PURPOSE: Approximately 23 million people struggle with medical debt in the U.S. This amounts to over $195 billion debt in collection. The burden of healthcare costs on patients is defined quantitatively as catastrophic health expenditures (CHE). The burden of CHE among surgical patients remains unknown. The goal of this study was to define the burden of CHE on surgical patients in the U.S. METHODS: Survey data from a nationally-representative sample of hospitalized adults undergoing surgery between 2016 and 2019 were analyzed using the Medical Expenditure Panel Survey. CHE was defined as out-of-pocket and premium costs greater than 10% of household income. Federal income subgroups included: lowest-income (138% or less of federal poverty level [FPL]), low-income (139%-250%FPL), middle-income (251%-400%FPL), and high-income (>400%FPL). Logistic regression models were used to estimate odds of CHE. RESULTS: Incidence of CHE was 24.9% in all surgical patients. Incidence was 49.2% for the lowest-income category, 28.3% for low-income, 22.1% for middle income, and 12.4% for high-income. Each descent in poverty category was associated with 52% increased odds of CHE (OR 0.657, 95% CI [0.627 - 0.690], p < 0.001). Incidence of CHE was 39.9% in the publicly insured, and 18.6% in privately insured. Patients with Medicare or Medicaid were four times more likely to experience CHE than the privately insured (OR 4.06, 95% CI [3.50 - 4.71], p < 0.001). CONCLUSION: Incidence of CHE after surgery is higher than previously modelled, with lowest-income and underinsured patients at highest risk. Identifying vulnerable populations facilitates implementation of targeted interventions.