Ehsan Anam N, Saha Shivangi, Hathi Preet, Vengadassalapathy Srinivasan, Sana Hamaiyal, Ganesh Praveen, Huang Chuan-Chin, Chauhan Shashank, Singhal Maneesh, Weissman Joel S, Atun Rifat, Sabapathy Shanmuganathan Raja, Ranganathan Kavitha
Brigham & Women's Hospital, Boston, MA.
All India Institute of Medical Science, New Delhi, Delhi.
J Craniofac Surg. 2025;36(1):128-131. doi: 10.1097/SCS.0000000000010761. Epub 2024 Oct 11.
Financial toxicity is the detrimental impact of health care costs that must be mitigated to achieve universal health coverage. Catastrophic health expenditure (CHE) is widely used to measure financial toxicity but does not capture patient perspectives of unaffordable health care costs. Financial hardship (FH), a patient-reported outcome measure, is currently underutilized but may be an important adjunct metric. The authors compare CHE to FH as metrics evaluating financial toxicity.
A prospective, multicenter cohort study was conducted across 3 public and private tertiary-care hospitals in India. Adult surgical trauma inpatients in plastic and orthopedic surgery departments were assessed. The development of CHE, health expenditures >10% of annual income, and FH, the patient-reported impact of financial toxicity in the form of asset liquidation, debt acquisition, and job loss, were compared by the health system and using logistic regression models.
Among 744 surgical trauma patients, low income, longer hospital stays, and increased injury severity were significantly associated with the likelihood of incurring CHE and FH (P<0.05). Only FH was significantly associated with lack of insurance (OR: 0.22; 95% CI: 1.14-2.71). Public hospitals had higher rates of FH than CHE (55% versus 23%). Private hospitals had more CHE than FH (53% versus 32%).
FH is an important metric of financial toxicity that provides important adjunct information to CHE for at-risk populations. FH is particularly informative for public institutions with low direct medical costs. Nuanced utilization of CHE and FH provides a more comprehensive, patient-oriented approach to evaluating unaffordable health care costs that can help shape financial risk protection policy.
经济毒性是医疗费用产生的有害影响，必须加以缓解以实现全民健康覆盖。灾难性卫生支出（CHE）被广泛用于衡量经济毒性，但未涵盖患者对难以承受的医疗费用的看法。经济困难（FH）是一种患者报告的结局指标，目前未得到充分利用，但可能是一个重要的辅助指标。作者将CHE与FH作为评估经济毒性的指标进行比较。
在印度的3家公立和私立三级医疗机构开展了一项前瞻性多中心队列研究。对整形外科和骨科的成年外科创伤住院患者进行评估。通过卫生系统并使用逻辑回归模型，比较了CHE（卫生支出>年收入的10%）和FH（患者报告的以资产清算、举债和失业形式出现的经济毒性影响）的发生情况。
在744例外科创伤患者中，低收入、住院时间延长和损伤严重程度增加与发生CHE和FH的可能性显著相关（P<0.05）。只有FH与未参保显著相关（比值比：0.22；95%置信区间：1.14 - 2.71）。公立医院的FH发生率高于CHE（55%对23%）。私立医院的CHE多于FH（53%对32%）。
FH是经济毒性的一个重要指标，为高危人群的CHE提供重要的辅助信息。对于直接医疗成本较低的公共机构，FH尤其具有参考价值。对CHE和FH进行细致入微的运用，可为评估难以承受的医疗费用提供一种更全面、以患者为导向的方法，有助于制定金融风险保护政策。
