Long after bleeding has stopped, wounds healed and pain subsided, people who survive severe traumatic injuries face a lasting scar on their financial health, a study has found.
The percentage of working-age people with medical debts so delinquent that a collection agency stepped in, and the size of those debts, were both much higher among those who had suffered an injury serious enough to require a stay. in hospital for the past two years. , compared to others like them.
Bankruptcy filings were also twice as high in the trauma group, according to data published in JAMA Health Forum by a team from the University of Michigan.
To make the most comprehensive comparison possible, the study used health care utilization and financial data from two groups of adults aged 18 to 65 who have the same type of commercial insurance but who suffered serious injuries in different years.
Those whose serious injuries occurred in the year and a half before the study’s financial “snapshot” were 23% more likely to have medical debts in collection and had 70% more medical debts in collection , compared to those whose injuries occurred after the financial toll. Check.
And while only a small percentage of either group went so far as to file for bankruptcy, it was twice as common among those who had been hospitalized for a traumatic injury in the past year and a half. .
The findings suggest the need to restructure health insurance plans to reduce or cap cost sharing for badly needed trauma care, says John Scott, MD, MPH, the paper’s first author. Scott, an assistant professor of surgery, cares for critically injured patients at Michigan Medicine, UM’s academic medical center.
“Much of our medical research to date has focused on improving outcomes while patients are in hospital, but our understanding of how patients’ lives are affected during their recovery has always been limited,” he said. “Our results show that the negative impact of traumatic injuries on patients’ lives does not end when they leave the hospital. Instead, they have bills they can’t pay, and there’s emerging evidence that this debt could further impact their ability to achieve an optimal recovery.
Scott worked with Nora Becker, MD, Ph.D., assistant professor of internal medicine, and others at the Michigan Health Economics and Affordability Lab (M-HEAL) to link the insurance records of nearly 5,400 people to their credit reports from January. 2021, in a way that protects their identity.
They chose people who had been hospitalized in 2019 and early 2020 (a group whose credit data was obtained “after the injury”) and a comparison group who were similar in many ways, except that their hospitalization for injury occurred in 2021 (a group whose data credit was obtained “before the injury”).
On average, the two groups spent an average of five days in hospital for their injury, including at least one night in intensive care for just over a third of the two groups.
Depending on how their health insurance plans are structured, these patients may have faced co-payments and deductibles of hundreds or thousands of dollars that they would have to pay out of pocket for hospital care and follow-up appointment, Scott notes.
While insurers and employers have primarily used deductibles and co-payments to reduce unnecessary health care use, the researchers note that post-traumatic care is largely not discretionary – it is necessary for the survival and better long-term outcomes.
“Nobody consumes too much trauma care just because their franchise is low,” Scott said. “Eliminate or cap deductibles for traumatic injuries – much like recent policies capping the cost of insulin for Medicare patients – could go a long way in ensuring that all patients can achieve optimal recovery after injury. If we fail to recognize the reality of the economic challenges our patients truly face, we risk driving them into destitution.
In addition to Scott and Becker, who also published findings on the financial cost of living with multiple chronic conditions, study authors include Kirstin W. Scott, MD, M.Phil., Ph.D.; Michelle Moniz, MD, M.Sc.; Erin F. Carlton, MD, M.Sc.; Renuka Tipirneni, MD, M.Sc. Most authors are members of the UM Institute for Healthcare Policy and Innovation and M-HEAL.
The study was funded by the Agency for Healthcare Research and Quality (HS028672, HS025465, HS028817).
Article quoted: “Financial Outcomes After Traumatic Injury Among American Working Age Adults with Commercial Insurance” JAMA Health Forum🇧🇷 DOI: 10.1001/jamahealthforum.2022.4105
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