Majority of Uninsured Trauma Patients Face Economic Hardship

A new study concludes that 70% of uninsured patients admitted for trauma care in the United States will face medical debt that could drive them into destitution.

Researchers at Harvard Medical School conducted a retrospective review of data regarding 579,683 uninsured nonelderly adults (18-64 years of age) who were admitted with primary diagnoses of trauma from 2007 to 2011 in the United States. U.S. Census data were used to estimate annual post-subsistence income and in-hospital charges for trauma-related admission. The primary outcome measure was catastrophic health expenditure (CHE) risk, defined as any charges composing over 40% of annual post-subsistence income.

The results showed that the median estimated annual income of uninsured patients was USD 40,867, and median inpatient charges were USD 27,420. Overall, 70.8% of all uninsured patients were at risk for CHE, and the finding was similar across most of the demographic subgroups. The greatest risk for CHE, however, was concentrated among patients from low-income communities and among patients with severe injuries (81.8%). The study was published on April 7, 2017, in Annals of Surgery.

“Medical debts are the greatest cause of bankruptcies in the United States; injuries are often unpredictable, expensive to treat, and disproportionally affect uninsured patients. Current measures of economic hardship are insufficient and exclude those at greatest risk,” concluded senior author Mark Shrime, MD, MPH, PhD, research director of the Harvard Program in Global Surgery and Social Change. “This analysis is the first application of CHE to a U.S. trauma population, and will be an important measure to evaluate the effectiveness of health care and coverage strategies to improve financial risk protection.”

CHE is an economic measure for out-of-pocket payments for healthcare made by households that can push them into poverty. The need to pay out-of-pocket can also mean that households do not seek care when they need it. According to the World Health Organization, an analysis of 108 surveys conducted in 86 countries has revealed that such catastrophic payments are incurred by less than 1% of households in some countries, and up to 13% in others. On average, Up to 5% of households globally are pushed into poverty.