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Catastrophic expenditures in California trauma patients after the Affordable Care Act: reduced financial risk and racial disparities.

Authors
  • Liu, Charles1
  • Rahman, Arifeen S2
  • Chao, Tiffany E3
  • 1 Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, United States; National Clinician Scholars Program, University of California Los Angeles, 1100 Glendon Ave, Suite 900, Los Angeles, CA 90024, United States; Veterans Administration Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073, United States. Electronic address: [email protected] , (United States)
  • 2 Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, United States. , (United States)
  • 3 Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, United States; Department of Surgery, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128, United States. , (United States)
Type
Published Article
Journal
American journal of surgery
Publication Date
Sep 01, 2020
Volume
220
Issue
3
Pages
511–517
Identifiers
DOI: 10.1016/j.amjsurg.2020.04.012
PMID: 32354603
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Hospital charges due to major injury can result in high out-of-pocket expenses for patients. We analyzed the effect of the Affordable Care Act (ACA) on catastrophic health expenditures (CHE) among trauma patients. We identified trauma patients aged 19-64 admitted to a safety-net Level 1 trauma center in California from 2007 to 2017. Out-of-pocket expenditures and income were calculated using hospital charges, insurance status, and ZIP code. CHE was defined using the World Health Organization definition of out-of-pocket spending exceeding 40% of inflation-adjusted income minus food and housing expenditures. Multivariable logistic regression was performed to assess odds of CHE post-ACA (2014-2017) vs. pre-ACA (2007-2013). Of 7519 trauma patients, 20.6% experienced CHE, including 89.0% of uninsured patients. There was a 74% decrease in odds of CHE post-ACA (aOR: 0.26, 95% CI: 0.22-0.30), with greater decreases among Black (aOR: 0.09, 95% CI: 0.04-0.18) and Hispanic (aOR: 0.23, 95% CI: 0.19-0.29) patients. ACA implementation was associated with markedly decreased odds of catastrophic expenditures and decreased racial disparities in financial protection among trauma patients in our study. Copyright © 2020 Elsevier Inc. All rights reserved.

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