The Personal Financial Burden Associated with Musculoskeletal Trauma

Abstract

Background: Little is known about the effect of orthopaedic trauma on the financial health of patients. We hypothesized that some patients who sustain musculoskeletal trauma experience considerable financial hardship during treatment, and we also assessed for factors associated with increased personal financial burden. Methods: We surveyed 236 of 393 consecutive patients who were approached at 1 of 2 American College of Surgeons level-I trauma centers between 2016 and 2017 following the completion of treatment for a musculoskeletal injury (60% response rate). Two validated measures (financial burden composite score and dichotomized worry score) were used to assess the financial hardship that patients experienced with the injury. Results: There were 236 participants in the study, the mean age was 56.3 years (range, 19 to 94 years), and 48.7% of patients were male. Of the 236 patients, 97.9% had medical insurance, yet the mean financial burden composite score (and standard deviation) was 2.4 ± 2.2 (0 indicated low and 6 indicated high). In this study, 25.0% of patients had high levels of worry about financial problems that resulted from the injury. Fifty-four percent of patients used their savings to pay for their care, and 23% of patients borrowed money or took out a loan. Twenty-three percent of patients missed payment on other bills. Fifty-seven percent of patients were required to cut expenses in general. Patients with higher composite financial burden scores had a significantly increased likelihood of high financial worry (odds ratio [OR], 1.8 [95% confidence interval (CI), 1.5 to 2.2]; p < 0.001). Factors associated with increased financial hardship were high-deductible health plan insurance (coefficient, 0.3 [95% CI, 0.002 to 0.528]; p = 0.048), Medicaid insurance (coefficient, 0.6 [95% CI, 0.342 to 0.863]; p < 0.001), failure to complete high school (coefficient, 0.475 [95% CI, 0.033 to 0.918]; p = 0.035), increased number of surgical procedures (coefficient, 0.067 [95% CI, 0.005 to 0.129]; p = 0.035), and prior medical or student loans (coefficient, 0.769 [95% CI, 0.523 to 1.016]; p < 0.001). Conclusions: Despite a high rate of insurance, patients with orthopaedic trauma in our study had high rates of worry and financial distress. Asking about financial hardship may help to identify those patients with a higher personal financial burden and may promote allocation of additional social support and services.

Financial Burden of Pediatric Anterior Cruciate Ligament Reconstruction

“…Given that most patients completed PT outside of our system, we were also limited in our ability to evaluate beyond duration and visit number, including important objective return-to-play metrics. Fifth, our sample size was limited by the number of isolated ACLRs performed at our institution, but our survey response rate of 45% was similar to those of previous studies of the financial burden of orthopaedic care 14,15. Finally, we studied patients treated at 1 academic institution in 1 state, so our results may not be generalizable to hospitals with different safety net and disproportionate sharing statuses.…”

“…Both are validated measures for assessment of financial hardship experienced with medical treatment 13. Both measures have been used to assess the financial burden associated with orthopaedic care in adults 14,15…”

Cost minimization analysis of the treatment of olecranon fracture in elderly patients: a retrospective analysis

“…26,27 One study found that a quarter of patients who experienced orthopaedic trauma had high financial distress, and nearly the same amount of patients needed to borrow money to pay for the costs, even though 97.9% of the sample had insurance. 28 Although indirect medical costs like transportation and lost time from paid work are more difficult to address, efforts to reduce costs in orthopaedic surgery could minimize a treatment's effect on financial distress. This study provides further evidence that nonoperative management leads to fewer complications in the elderly population.…”

“…In orthopaedic surgery, patients have been shown to postpone visits and have higher levels of subjective disability as a result of financial distress 26,27. One study found that a quarter of patients who experienced orthopaedic trauma had high financial distress, and nearly the same amount of patients needed to borrow money to pay for the costs, even though 97.9% of the sample had insurance 28. Although indirect medical costs like transportation and lost time from paid work are more difficult to address, efforts to reduce costs in orthopaedic surgery could minimize a treatment’s effect on financial distress.…”

Clinic follow-up of orthopaedic trauma patients during and after the post-surgical global period: a retrospective cohort study

“…In Massachusetts, recent health reforms led to an increased number of insured individuals [ 3 , 4 ]. However, even among insured patients, the amount of financial burden caused by medical expenditures varies considerably [ 5 ]. When considering treatment adherence after unexpected musculoskeletal trauma, financial burden is especially important as medical expenses may prevent low-income populations from accessing follow-up services.…”