Hostname: page-component-7479d7b7d-qlrfm Total loading time: 0 Render date: 2024-07-13T17:34:43.224Z Has data issue: false hasContentIssue false

Out-of-pocket medical expenses in severe CHD

Published online by Cambridge University Press:  20 June 2018

Justin J. Elhoff*
Affiliation:
Texas Children’s Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Kimberly E. McHugh
Affiliation:
Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
Jason R. Buckley
Affiliation:
Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
Shaine A. Morris
Affiliation:
Texas Children’s Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Kit N. Simpson
Affiliation:
Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC, USA
Mark A. Scheurer
Affiliation:
Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
*
Author for correspondence: J. J. Elhoff, MD, Texas Children’s Hospital, 6621 Fannin Street, Suite W6006, Houston, TX 77030, USA. Tel: 832 826 0634; Fax: 832 825 7422; E-mail: jxelhoff@texaschildrens.org

Abstract

Introduction

Families of children born with CHD face added stress owing to uncertainty about the magnitude of the financial burden for medical costs they will face. This study seeks to assess the family responsibility for healthcare bills during the first 12 months of life for commercially insured children undergoing surgery for severe CHD.

Methods

The MarketScan® database from Truven was used to identify commercially insured infants in 39 states from 2010 to 2012 with an ICD-9 diagnosis code for transposition of the great arteries, tetralogy of Fallot, or truncus arteriosus, as well as the corresponding procedure code for complete repair. Data extraction identified payment responsibilities of the patients’ families in the form of co-payments, deductibles, and co-insurance during the 1st year of life.

Results

There were 481 infants identified who met the criteria. Average family responsibility for healthcare bills during the 1st year of life was $2928, with no difference between the three groups. The range of out-of-pocket costs was $50–$18,167. Initial hospitalisation and outpatient care accounted for the majority of these responsibilities.

Conclusions

Families of commercially insured children with severe CHD requiring corrective surgery face an average of ~$3000 in out-of-pocket costs for healthcare bills during the first 12 months of their child’s life, although the amount varied considerably. This information provides a framework to alleviate some of the uncertainty surrounding healthcare financial responsibilities, and further examination of the origination of these expenditures may be useful in informing future healthcare policy discussion.

Type
Original Article
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Cite this article: Elhoff JJ, McHugh KE, Buckley JR, Morris SA, Simpson KN, Scheurer MA. (2018) Out-of-pocket medical expenses in severe CHD. Cardiology in the Young28: 1014–1018. doi: 10.1017/S1047951118000768

References

1. Werner, H, Latal, B, Valsangiacomo Buechel, E, Beck, I, Landolt, MA. The impact of an infant’s severe congenital heart disease on the family: a prospective cohort study. Congenit Heart Dis 2014; 9: 203210.CrossRefGoogle ScholarPubMed
2. Connor, JA, Kline, NE, Mott, S, Harris, SK, Jenkins, KJ. The meaning of cost for families of children with congenital heart disease. J Pediatr Health Care 2010; 24: 318325.CrossRefGoogle ScholarPubMed
3. Franck, LS, McQuillan, A, Wray, J, Grocott, MP, Goldman, A. Parent stress levels during children’s hospital recovery after congenital heart surgery. Pediatr Cardiol 2010; 31: 961968.CrossRefGoogle ScholarPubMed
4. Jackson, AC, Frydenberg, E, Liang, RP, Higgins, RO, Murphy, BM. Familial impact and coping with child heart disease: a systematic review. Pediatr Cardiol 2015; 36: 695712.CrossRefGoogle ScholarPubMed
5. Connor, JA, Gauvreau, K, Jenkins, KJ. Factors associated with increased resource utilization for congenital heart disease. Pediatrics 2005; 116: 689695.CrossRefGoogle ScholarPubMed
6. Benavidez, OJ, Connor, JA, Gauvreau, K, Jenkins, KJ. The contribution of complications to high resource utilization during congenital heart surgery admissions. Congenit Heart Dis 2007; 2: 319326.CrossRefGoogle ScholarPubMed
7. Pasquali, SK, Sun, JL, d’Almada, P, et al. Center variation in hospital costs for patients undergoing congenital heart surgery. Circ Cardiovasc Qual Outcomes 2011; 4: 306312.CrossRefGoogle ScholarPubMed
8. Pasquali, SK, Gaies, MG, Jacobs, JP, William Gaynor, J, Jacobs, ML. Centre variation in cost and outcomes for congenital heart surgery. Cardiol Young 2012; 22: 796799.CrossRefGoogle ScholarPubMed
9. Pasquali, SK, Jacobs, ML, He, X, et al. Variation in congenital heart surgery costs across hospitals. Pediatrics 2014; 133: e553e560.CrossRefGoogle ScholarPubMed
10. Raucci, FJ Jr., Hoke, TR, Gutgesell, HP. Predicting economic and medical outcomes based on risk adjustment for congenital heart surgery classification of pediatric cardiovascular surgical admissions. Am J Cardiol 2014; 114: 17401744.CrossRefGoogle ScholarPubMed
11. Romley, JA, Chen, AY, Goldman, DP, Williams, R. Hospital costs and inpatient mortality among children undergoing surgery for congenital heart disease. Health Serv Res 2014; 49: 588608.CrossRefGoogle ScholarPubMed
12. Smith, AH, Gay, JC, Patel, NR. Trends in resource utilization associated with the inpatient treatment of neonatal congenital heart disease. Congenit Heart Dis 2014; 9: 96105.CrossRefGoogle ScholarPubMed
13. Chan, T, Kim, J, Minich, LL, Pinto, NM, Waitzman, NJ. Surgical volume, hospital quality, and hospitalization cost in congenital heart surgery in the United States. Pediatr Cardiol 2015; 36: 205213.CrossRefGoogle Scholar
14. Faraoni, D, Nasr, VG, DiNardo, JA. Overall hospital cost estimates in children with congenital heart disease: analysis of the 2012 Kid’s Inpatient Database. Pediatr Cardiol 2016; 37: 3743.CrossRefGoogle ScholarPubMed
15. Dockerty, JD, Skegg, DC, Williams, SM. Economic effects of childhood cancer on families. J Paediatr Child Health 2003; 39: 254258.CrossRefGoogle ScholarPubMed
16. Looman, WS, O’Conner-Von, SK, Ferski, GJ, Hildenbrand, DA. Financial and employment problems in families of children with special health care needs: implications for research and practice. J Pediatr Health Care 2009; 23: 117125.CrossRefGoogle ScholarPubMed
17. Newacheck, PW, Houtrow, AJ, Romm, DL, et al. The future of health insurance for children with special health care needs. Pediatrics 2009; 123: e940e947.CrossRefGoogle ScholarPubMed
18. Parish, SL, Shattuck, PT, Rose, RA. Financial burden of raising CSHCN: association with state policy choices. Pediatrics 2009; 124 (Suppl 4): S435S442.CrossRefGoogle ScholarPubMed
19. Porterfield, SL, DeRigne, L. Medical home and out-of-pocket medical costs for children with special health care needs. Pediatrics 2011; 128: 892900.CrossRefGoogle ScholarPubMed
20. Pelletier, W, Bona, K. Assessment of financial burden as a standard of care in pediatric oncology. Pediatr Blood Cancer 2015; 62 (Suppl 5): S619S631.CrossRefGoogle ScholarPubMed
21. Thomson, J, Shah, SS, Simmons, JM, et al. Financial and social hardships in families of children with medical complexity. J Pediatr 2016; 172: 187193.e181.CrossRefGoogle ScholarPubMed
22. Chen, AY, Newacheck, PW. Insurance coverage and financial burden for families of children with special health care needs. Ambul Pediatr 2006; 6: 204209.CrossRefGoogle ScholarPubMed
23. Jeffrey, AE, Newacheck, PW. Role of insurance for children with special health care needs: a synthesis of the evidence. Pediatrics 2006; 118: e1027e1038.CrossRefGoogle Scholar
24. Yu, H, Dick, AW, Szilagyi, PG. Does public insurance provide better financial protection against rising health care costs for families of children with special health care needs? Med Care. 2008; 46: 10641070.CrossRefGoogle ScholarPubMed
25. DeRigne, L. The employment and financial effects on families raising children with special health care needs: an examination of the evidence. J Pediatr Health Care 2012; 26: 283290.CrossRefGoogle ScholarPubMed
26. Ghandour, RM, Comeau, M, Tobias, C, et al. Assuring adequate health insurance for children with special health care needs: progress from 2001 to 2009-2010. Acad Pediatr 2015; 15: 451460.CrossRefGoogle ScholarPubMed
27. Manning, WG, Basu, A, Mullahy, J. Generalized modeling approaches to risk adjustment of skewed outcomes data. J Health Econ 2005; 24: 465488.CrossRefGoogle ScholarPubMed
Supplementary material: File

Elhoff et al. supplementary material

Table S1

Download Elhoff et al. supplementary material(File)
File 54.1 KB
Supplementary material: File

Elhoff et al. supplementary material

Table S2

Download Elhoff et al. supplementary material(File)
File 50.8 KB