Out-of-Pocket Expenses Associated with Hand Trauma: A 12-Month Analysis After Injury

INTRODUCTION: Hand injuries impose financial burdens that can delay care and impact outcomes. However, there is a lack of information about the impact of different patient, injury, and health system factors that drive patient out-of-pocket (OOP) expenses. METHODS: We performed a retrospective study (2016-2023) examining patients with surgically treated hand trauma. Patients were separated into two cohorts based on their treatment hospital (public safety-net and private community hospital). OOP expenses at 3-, 6-, and 12-months post-operatively were collected. Generalized linear models examined the effects of patient characteristics on cumulative 12-month OOP expenses. RESULTS: There were 819 patients treated at the public safety-net hospital and 313 patients at the private community hospital. At the public safety-net hospital, 72% of patients were enrolled in the Financial Assistance Program while 20% were enrolled in commercial insurance. At the private community hospital, 74% of patients had commercial insurance and 26% had Medicare/Medicaid. Twelve-month OOP expenses at private community hospital were 37% of the expenses compared to the public safety-net hospital (95% CI: 0.29-0.46). Patients with commercial insurance had higher predicted 12-month OOP expenses at both hospital systems (safety-net: $2,835, 95% CI: $2161-$3720; private: $1,036, 95% CI: $790-$1361) compared to Medicare/Medicaid (safety-net: $1,590, 95% CI: $1160-$2180; private: $352, 95% CI: $258-$483). CONCLUSION: OOP expenses after surgical intervention for hand trauma were associated with insurance coverage and hospital setting, rather than patient or injury specific factors. These findings highlight the need for policies that promote price transparency and protect patients from financial burden after hand trauma.