Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA.
Ann Surg. 2018 Jun;267(6):1093-1099. doi: 10.1097/SLA.0000000000002254.
To characterize the economic hardship for uninsured patients admitted for trauma using catastrophic health expenditure (CHE) risk.
Medical debts are the greatest cause of bankruptcies in the United States. Injuries are often unpredictable, expensive to treat, and disproportionally affect uninsured patients. Current measures of economic hardship are insufficient and exclude those at greatest risk.
We performed a retrospective review, using data from the 2007-2011 Nationwide Inpatient Samples of all uninsured nonelderly adults (18-64 yrs) admitted with primary diagnoses of trauma. We used US Census data to estimate annual postsubsistence income and inhospital charges for trauma-related admission. Our primary outcome measure was catastrophic health expenditure risk, defined as any charges ≥40% of annual postsubsistence income.
Our sample represented 579,683 admissions for uninsured nonelderly adults over the 5-year study period. Median estimated annual income was $40,867 (interquartile range: $21,286-$71.733). Median inpatient charges were $27,420 (interquartile range: $15,196-$49,694). Overall, 70.8% (95% posterior confidence interval: 70.7%-71.1%) of patients were at risk for CHE. The risk of CHE was similar across most demographic subgroups. The greatest risk, however, was concentrated among patients from low-income communities (77.5% among patients in the lowest community income quartile) and among patients with severe injuries (81.8% among those with ISS ≥ 16).
Over 7 in 10 uninsured patients admitted for trauma are at risk of catastrophic health expenditures. This analysis is the first application of CHE to a US trauma population and will be an important measure to evaluate the effectiveness of health care and coverage strategies to improve financial risk protection.
使用灾难性卫生支出（CHE）风险来描述因创伤而接受治疗的无保险患者的经济困难情况。
在美国，医疗债务是导致破产的最大原因。伤害往往是不可预测的，治疗费用昂贵，而且不成比例地影响无保险的患者。当前的经济困难衡量标准不足，且排除了那些面临最大风险的人群。
我们进行了一项回顾性研究，使用了 2007 年至 2011 年全美住院患者样本中所有无保险的非老年成年人（18-64 岁）的主要创伤诊断入院数据。我们使用美国人口普查数据来估计与创伤相关的住院费用和年度生存后收入。我们的主要结果衡量指标是灾难性卫生支出风险，定义为任何费用≥年度生存后收入的 40%。
在 5 年的研究期间，我们的样本代表了 579683 例无保险的非老年成年人因创伤而住院。估计的年平均收入中位数为 40867 美元（四分位距：21286-71733 美元）。住院费用中位数为 27420 美元（四分位距：15196-49694 美元）。总体而言，70.8%（95%后验置信区间：70.7%-71.1%）的患者存在 CHE 风险。大多数人口统计学亚组的 CHE 风险相似。然而，最大的风险集中在来自低收入社区的患者中（收入最低的社区收入四分位数中为 77.5%）和严重受伤的患者中（ISS≥16 的患者中为 81.8%）。
超过 7 成因创伤而接受治疗的无保险患者面临灾难性卫生支出的风险。这项分析是 CHE 在美国创伤人群中的首次应用，将是评估医疗保健和覆盖策略有效性以改善财务风险保护的重要衡量标准。
