Financial Hardship After Traumatic Injury: Risk Factors and Drivers of Out-of-Pocket Health Expenses

Kathleen M. O'Neill, Raymond A. Jean, Cary P. Gross, Robert D. Becher, Rohan Khera, Javier Valero Elizondo, Khurram Nasir

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: Trauma-related disorders rank among the top five most costly medical conditions to the health care system. However, the impact of out-of-pocket (OOP) health expenses for traumatic conditions is not known. In this cross-sectional study, we use nationally representative data to investigate whether patients with a traumatic injury experienced financial hardship from OOP health expenses. Methods: Using data from the Medical Expenditure Panel Survey from 2010 to 2015, we analyzed the financial burden associated with a traumatic injury. Primary outcomes were excess financial burden (OOP>20% of annual income) and catastrophic medical expenses (OOP>40% of annual income). A multivariable logistic regression analysis evaluated whether these outcomes were associated with traumatic injury, adjusting for demographic, socioeconomic, and health care factors. We then completed a descriptive analysis to elucidate drivers of total OOP expenses. Results: Of the 90,964 families in the cohort, 6434 families had a traumatic injury requiring a visit to the emergency room and 668 families had a traumatic injury requiring hospitalization. Overall 1 in 8 households with an injured family member requiring hospitalization experienced financial hardship. These families were more likely to experience excess financial burden (OR: 2.04, 95% CI: 1.13-3.64) and catastrophic medical expenses (OR: 3.08, 95% CI: 1.37-6.9). The largest burden of OOP expenses was due to prescription drug costs, with inpatient costs as a major driver of OOP expenses for those requiring hospitalization. Conclusions: Households with an injured family member requiring hospitalization are significantly more vulnerable to financial hardship from OOP health expenses than the noninjured population. Prescription drug and inpatient costs were the most significant drivers of OOP health expenses.

Original languageEnglish (US)
Pages (from-to)1-12
Number of pages12
JournalJournal of Surgical Research
StatePublished - Dec 2020


  • Cost
  • Financial hardship
  • Insurance
  • Out-of-pocket expenses
  • Trauma
  • Humans
  • Middle Aged
  • Child, Preschool
  • Cost of Illness
  • Wounds and Injuries/economics
  • Infant
  • Male
  • Insurance, Health/economics
  • Socioeconomic Factors
  • Young Adult
  • Prescription Drugs/economics
  • United States/epidemiology
  • Adult
  • Female
  • Health Expenditures/statistics & numerical data
  • Retrospective Studies
  • Child
  • Infant, Newborn
  • Financial Stress/economics
  • Hospitalization/economics
  • Cross-Sectional Studies
  • Risk Factors
  • Adolescent
  • Family
  • Aged

ASJC Scopus subject areas

  • Surgery


Dive into the research topics of 'Financial Hardship After Traumatic Injury: Risk Factors and Drivers of Out-of-Pocket Health Expenses'. Together they form a unique fingerprint.

Cite this