Abstract

Predicting the Risk of Catastrophic Surgical Expenditure in a Community-Based Primary and Preventative Care Program

Gregory Schneider, MD¹, Alexa Denton ², Matthew Hey ², Mackenzie Mayhew ², Anna Kenney ², Jamie Fairclough ³, Rupa Seetharamaiah ², Shahab Shaffiey ⁴ (1)Florida International University Herbert Wertheim College of Medicine , (2)Florida International University Herbert Wertheim College of Medicine, (3)Roseman University of Health Sciences , (4)Nicklaus Children's Hospital

APHA 2022 Annual Meeting and Expo

Background
Medical expenditures are the most common cause of bankruptcy in the United States. A catastrophic surgical expenditure (CSE) involves costs for surgery that can pose a threat towards a household’s financial ability to maintain its subsistence needs. This study examines the risks of CSE among uninsured households enrolled in a medical and social service program for underserved communities in Miami-Dade County called NeighborhoodHELP.

Methods
Using established methodology for calculating CSE from the World Health Organization, we determined the risk of CSE among all 851 households enrolled in NeighborhoodHELP as of 2/28/2020. Briefly, an expenditure is “catastrophic when the out-of-pocket (OOP) burden times the cost of the surgery exceeds a threshold for non-subsistence household expenditures, i.e., 40%. We then determined how different rates of insurance coverage, which affect the OOP burden, changed the risks.

Results
Among the 758 households for which we had adequate data, median household size was 2, with median household expenditure of $27,043. 41.42% of households fell below federal poverty standards. Using average costs for an uninsured patient for an appendectomy or cholecystectomy in 2019, 41-44% of our households are at risk for CSE. Using average costs for insured patients for the same surgeries in 2019, only 7-8% of households would be at risk.

Discussion
Insurance coverage, in particular Medicaid expansion, would greatly reduce the risks of CSE among the underserved households in our program. Future research should consider sub-group analysis looking at different types of insurance coverage and at other interventions to protect at-risk households.