Presented by: Justin Ziemba MD, MSEd
University of Pennsylvania

Introduction

The financial burdens that healthcare places on patients is termed financial toxicity. The vulnerability to experiencing financial toxicity was assessed in a cohort of patients undergoing surgical stone management.

Materials

Adults undergoing ureteroscopy or nephrolithotomy for renal/ureteral stones were eligible for inclusion (1/2022 – 1/2023). Patients prospectively completed a modified version of the Commonwealth Biennial Health Insurance questionnaire, which measures health insurance coverage, affordability, and financial impact of medical bills. The questionnaire was completed electronically pre-operatively (POD 0).

Results

,

 Total of 88 participants were enrolled with a median age of 50 (IQR 40-60), 52% male, and 77% white. The majority underwent ureteroscopy (73/88; 83%), unilateral (85/88; 97%), and with the dominant stone in a kidney only stone location (40/88; 45%). Participants were mostly employed full-time (53/88; 60%), had a high education level (52/88; 59% 4-year college or more), and a wealthy median household income (38/88; 43% $100,000 or more). All participants were insured (68/68; 100%) with the majority having private insurance through an employer (60/88; 68%). Figure 1 shows the insurance cost associated with deductible and out-of-pocket costs. Figure 2 shows the impact of insurance and healthcare costs on personal decisions and finances. Figure 3 shows the burden of medical debt. There was no difference in these impact measures between those with and without private insurance.

Conclusion

Despite our patient population being well educated and universally insured, a significant subset of patients are highly vulnerable to financial toxicity and have low financial literacy.

Funding

None

Co-Authors

Katharine Michel, MD, MSHP
University of Pennsylvania

Benjamin Schurhamer, MD
University of Pennsylvania

George Lin, BS
University of Pennsylvania

Hanna Stambakio, MSE, MPH
University of Pennsylvania