The Association Between Insurance Type and Financial Toxicity in Older Adult Surgical Patients

Area of Science:

• Health Economics
• Surgical Outcomes
• Geriatric Medicine

Background:

• Financial toxicity (FT) is a significant burden for surgical patients.
• Older adults (≥65 years) in the US have diverse insurance options: Medicare, Medicare Advantage (MA), and private insurance.
• Understanding FT across these insurance types is crucial for this demographic.

Purpose of the Study:

• To examine financial toxicity (FT) among US adults aged 65 years and older who underwent inpatient surgery.
• To compare FT prevalence, out-of-pocket (OOP) costs, and total healthcare expenditures (THE) across Medicare, Medicare Advantage (MA), and private insurance plans.

Main Methods:

• Analysis of adults ≥65 years with Medicare, MA, or private insurance undergoing inpatient surgery using the Medical Expenditure Panel Survey (2017-2022).
• FT defined as difficulty paying medical bills, delaying medications, or postponing care due to cost.
• Logistic and linear regression models used to estimate adjusted odds of FT, OOP costs, and THE by insurance type.

Main Results:

• Among 6.7 million older surgical patients, 21.9% reported FT.
• FT rates were 24.6% for Medicare, 23.2% for MA, and 19.2% for private insurance (P=0.047).
• Total healthcare expenditures (THE) were significantly higher for MA (+$1,823) and private insurance (+$3,842) compared to Medicare, with similar FT odds across all plans.

Conclusions:

• Financial toxicity remains prevalent in older adult surgical patients, even with subsidized insurance like Medicare Advantage.
• Private and MA plans are associated with higher total healthcare costs than traditional Medicare without a demonstrable reduction in FT.
• Further research is needed to understand patient insurance selection drivers and optimize plans to mitigate financial toxicity in this population.