The Personal Financial Burden Associated with Musculoskeletal Trauma

Background: Little is known about the effect of orthopaedic trauma on the financial health of patients. We hypothesized that some patients who sustain musculoskeletal trauma experience considerable financial hardship during treatment, and we also assessed for factors associated with increased personal financial burden. Methods: We surveyed 236 of 393 consecutive patients who were approached at 1 of 2 American College of Surgeons level-I trauma centers between 2016 and 2017 following the completion of treatment for a musculoskeletal injury (60% response rate). Two validated measures (financial burden composite score and dichotomized worry score) were used to assess the financial hardship that patients experienced with the injury. Results: There were 236 participants in the study, the mean age was 56.3 years (range, 19 to 94 years), and 48.7% of patients were male. Of the 236 patients, 97.9% had medical insurance, yet the mean financial burden composite score (and standard deviation) was 2.4 +/- 2.2 (0 indicated low and 6 indicated high). In this study, 25.0% of patients had high levels of worry about financial problems that resulted from the injury. Fifty-four percent of patients used their savings to pay for their care, and 23% of patients borrowed money or took out a loan. Twenty-three percent of patients missed payment on other bills. Fifty-seven percent of patients were required to cut expenses in general. Patients with higher composite financial burden scores had a significantly increased likelihood of high financial worry (odds ratio [OR], 1.8 [95% confidence interval (CI), 1.5 to 2.2]; p < 0.001). Factors associated with increased financial hardship were high-deductible health plan insurance (coefficient, 0.3 [95% CI, 0.002 to 0.528]; p = 0.048), Medicaid insurance (coefficient, 0.6 [95% CI, 0.342 to 0.863]; p < 0.001), failure to complete high school (coefficient, 0.475 [95% CI, 0.033 to 0.918]; p = 0.035), increased number of surgical procedures (coefficient, 0.067 [95% CI, 0.005 to 0.129]; p = 0.035), and prior medical or student loans (coefficient, 0.769 [95% CI, 0.523 to 1.016]; p < 0.001). Conclusions: Despite a high rate of insurance, patients with orthopaedic trauma in our study had high rates of worry and financial distress. Asking about financial hardship may help to identify those patients with a higher personal financial burden and may promote allocation of additional social support and services.