SP44. Racial and Economic Disparities in Plastic Surgery Access and Financial Burden: A National Analysis Utilizing the Medical Expenditure Panel Survey

PURPOSE: Significant disparities exist in Plastic Surgery across economic and demographic domains, with financial toxicity, defined as financial hardship as a result of medical care, increasingly affecting patients. Cosmetic surgery spending has surged in recent years, which can disproportionately impact racial minorities and lower-income groups. Out-of-pocket costs have risen sharply, particularly in the Western United States, and among individuals enrolled in health plans requiring higher patient cost-sharing, exacerbating issues like insurance churn, defined as the loss and regain of coverage that disrupts continuity of medical care. Smoking, obesity, and advanced breast cancer further increase financial burdens through complications. This study utilizes data from the Medical Expenditure Panel Survey (MEPS) to identify trends and provide insights for improving surgical access and reducing financial toxicity among Plastic Surgery patients. METHODS: Data from the 1999-2022 Medical Expenditure Panel Survey (MEPS) was analyzed, focusing on office-based visits filtered for plastic surgery encounters. Patient demographics, insurance status, job changes, and income information were extracted from the consolidated data files. Using survey weights, Taylor series linearization was applied to generate weighted mean statistics by race and estimate outcome measures like insurance churn. Office-based expenditures were calculated as the total expenditures reported per respondent within a survey panel. This approach allowed for analysis of financial toxicity and disparities in Plastic Surgery utilization over time. RESULTS: Our analysis revealed significant racial and economic disparities in Plastic Surgery utilization, financial burden, and employment outcomes. Black individuals had higher insurance loss and periods of uninsurance compared to other groups, with Asian individuals reporting the highest rate of being consistently uninsured. All racial groups experienced catastrophic health expenditures—defined as healthcare-related costs exceeding 10% of income—at high rates, with Black patients being most significantly impacted at around 10%. Economic disparities were stark, with poorer individuals facing significantly higher catastrophic health expenditures (36.6%) compared to high-income individuals (9.9%). Non-employment outcomes also varied, with Native Hawaiian/Pacific Islanders experiencing the highest job loss (8.3%) and multiracial patients having the most missed workdays due to illness (41.7%). CONCLUSION: Our findings underscore critical disparities particularly relevant to Plastic Surgery, a field encompassing both reconstructive and elective procedures, revealing significant racial and economic inequalities in access to care, insurance stability, and financial burden. Black and Asian individuals experienced higher rates of insurance churn and catastrophic health expenditures, while lower-income groups faced substantially greater financial toxicity. These disparities, including higher rates of insurance churn and catastrophic health expenditures among racial minorities and economically disadvantaged groups, pose significant barriers to both functional and aesthetic surgical interventions. For reconstructive plastic surgery, often necessary for restoring function and improving patient quality of life, these barriers impede timely and equitable access to care. Similarly, for elective cosmetic procedures, financial instability disproportionately limits access for vulnerable populations despite the significant psychosocial benefits associated with these interventions. For practicing plastic surgeons, this data highlights the need to address systemic disparities through policy advocacy, reduce financial barriers, and enhance access to care, ultimately improving patient outcomes and promoting health equity within the field.