The Association of Financial Distress With Disability in Orthopaedic Surgery

Abstract

Introduction: Increased out-of-pocket costs have led to patients bearing more of the financial burden for their care. Previous work has shown that financial burden and distress can affect outcomes, symptoms, satisfaction, and adherence to treatment. We asked the following questions: (1) Does patients' financial distress correlate with disability in patients with nonacute orthopaedic conditions? (2) Do patient demographic factors affect this correlation? Methods: We conducted a cross-sectional, observational study of new patients presenting to a multispecialty orthopaedic clinic with a nonacute orthopaedic complication. Patients completed a demographics questionnaire, the InCharge Financial Distress/Financial Well-Being Scale, and the Health Assessment Questionnaire Disability Index. Statistical analysis was done using Pearson's correlation. Results: The mean score for financial distress was 4.10 (SD, 2.09; scale 1 [low distress] to 10 [high distress]; range, 1.13 to 10.0), and the mean disability score was 0.54 (SD, 0.65; scale 0 to 3; range, 0 to 2.75). A moderate positive correlation exists between financial distress and disability (r = 0.43; P < 0.01). Financial distress and disability were highest for poor, uneducated, Medicare patients. Conclusions: A moderate correlation exists between financial distress and disability in patients with nonacute orthopaedic conditions, particularly in patients with low socioeconomic status. Orthopaedic surgeons may benefit from identifying patients in financial distress and discussing the cost of treatment because of its association with disability and potentially inferior outcomes. Further investigation is needed to test whether decreasing financial distress decreases disability. Level of Evidence: Level III prospective cohort

Financial Distress Is Associated With Delay in Seeking Care for Hand Conditions

“…38 Therefore, willingness of hand surgeons to discuss major costs, such as those of elective hand surgery, with patients may help directly reduce financial distress and its deleterious effects, such as delayed care and/or disability. 8 The most common reason reported by patients for delaying their current visit was "thought problem would go away or was not serious enough" (Table 5). Surprisingly, only 10% of those who delayed their visit to the hand clinic explicitly cited cost as a reason, suggesting that financial distress exerts an effect on delay of care through a different mechanism.…”

“…38 Therefore, willingness of hand surgeons to discuss major costs, such as those of elective hand surgery, with patients may help directly reduce financial distress and its deleterious effects, such as delayed care and/or disability. 8…”

“…12 This phenomenon is of additional importance because financial distress-related delay in hand surgery could represent a source of preventable work or functional disability. 8 Thus, studies are needed to examine whether financial distress is associated with delay of care in hand surgery. Although several studies have investigated barriers to care access in orthopaedic surgery, these have largely relied on surrogate measures of financial status such as insurance type and surrogate outcomes such as the ability to successfully obtain an office appointment.…”

“…5,6 Increased financial distress has been associated with disability in orthopaedic patients and the use of cost-coping mechanisms such as delaying treatment or skipping clinic visits in cancer patients. 7,8 Lack of health insurance, underinsurance, financial concerns about care access among insured populations, and low income have each been linked to delays in seeking care and/or forgoing care altogether. 9,10 Notably, a recent study showed that increased financial distress was associated with delaying or forgoing general medical care due to cost, with a particularly striking result that 41% of the insured population also reported delaying or forgoing care due to cost.…”

Short-term Disability Insurance, Return to Work, and the Responsibility of the Orthopaedic Surgeon

“…In their study, financial distress was measured on an 8-item instrument that asked patients to rate their financial situation on a scale of 1 to 10, with 1 representing overwhelming stress/dissatisfaction and 10 representing no stress and complete satisfaction called the InCharge Financial Distress/Financial Well-being Scale. 18 By using the Health Assessment Questionnaire Disability Index, they found that patients making less than $50,000 per year had the highest financial distress and disability of all income brackets. 18 One of the most important modifiable predictors of the rate of RTW is self-efficacy-an individual's belief in his or her capacity to execute behaviors necessary to produce specific performance attainments.…”