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Out-of-pocket medical expenses in severe CHD

Published online by Cambridge University Press:  20 June 2018

Justin J. Elhoff ,
Kimberly E. McHugh Open the ORCID record for Kimberly E. McHugh [Opens in a new window] ,
Jason R. Buckley ,
Shaine A. Morris ,
Kit N. Simpson  and
Mark A. Scheurer
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
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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.

Keywords

Healthcare costsfinancial burdenpaediatric cardiologyfamily impactCHD
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 8 , August 2018 , pp. 1014 - 1018
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Copyright
© Cambridge University Press 2018 

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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

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