Abstract 20508: Out-of-Pocket Medical Costs in Severe Congenital Heart Disease
Introduction: Families of children born with congenital heart disease (CHD) face myriad stressors. These include financial burdens, which are compounded by uncertainty regarding the amount of responsibility the family will assume for medical bills. Out-of-pocket medical costs for these families has not previously been reported. This study describes the family responsibility for healthcare bills during the first 12 months of life for commercially insured children undergoing surgical repair for transposition of the great arteries, tetralogy of Fallot, and truncus arteriosus.
Methods: The MarketScan database was used to identify commercially insured infants carrying an ICD-9 diagnosis code for one of three forms of severe CHD as well as the corresponding procedure code for corrective operation from 2010-2012. Data extraction determined inpatient, outpatient, and pharmaceutical payment responsibilities of the patients’ families in the form of copayments, deductibles, and co-insurance during their first year of life.
Results: 481 infants with severe CHD undergoing surgical repair were identified (Table 1). The average family responsibility for medical bills was approximately $3000, and some families faced as much as $11,000 in medical bills for which they were responsible. Index hospitalization accounted for 28-37% of out-of-pocket costs, compared to 12-17% for follow-up hospitalization(s), 7-15% for prescriptions, and 38-45% for outpatient visits.
Conclusions: Families of commercially insured children with severe CHD requiring corrective surgery face an average of approximately $3,000 in out-of-pocket costs for healthcare bills over the first 12 months of their child’s life. While these families face enormous additional emotional and financial burdens, this information may provide a framework to alleviate some of the uncertainty surrounding healthcare financial responsibilities.
- Congenital heart disease
- Pediatric cardiology
- Patient education/teaching psychosocial aspects
- Pediatric cardiac intensive care
- Patient centered care
Author Disclosures: J. Elhoff: None. K. McHugh: None. J. Buckley: None. K. Simpson: None. M. Scheurer: None.
- © 2016 by American Heart Association, Inc.