The Risk of Catastrophic Surgical Expenditure Within a Community-Based Primary and Preventive Care Program at a...

Introduction Catastrophic surgical expenditure (CSE) poses significant financial risks globally. This modeling study investigates the risk of CSE among underserved households enrolled in a primary and preventive care program at a US community-based medical school. Materials and methods Using World Health Organization methodology, the analysis estimates the risk of these households suffering a CSE for an emergency cholecystectomy, adjusting for varying rates of insurance coverage. A place-based indicator of social deprivation - the Area Deprivation Index (ADI) score - was evaluated for correlation with CSE risk. Results Findings reveal that significant percentages of households face CSE risk, ranging from 7.7% to 88.92%, depending on insurance status and payment burden assumed. Importantly, ADI scores show a significant correlation with CSE risk. Higher ADI scores correlated with increased CSE risk, particularly for uninsured households. Discussion The study underscores the critical need for health insurance expansion and interventions to mitigate CSE risks, especially in low-income communities. Additionally, it proposes the use of place-based indicators like ADI to aid in identifying households at risk for CSE and to inform targeted interventions and policy discussions. Despite limitations, the study provides valuable insights into addressing financial vulnerability in healthcare and highlights avenues for further research and intervention. Conclusion Neighborhood-based modeling demonstrates the financial fragility of underserved communities and supports using place-based indicators like ADI in health policy, screening, and program design to reduce surgical financial catastrophe.