# The Risk of Catastrophic Surgical Expenditure Within a Community-Based Primary and Preventive Care Program at a Florida Medical School: A Modeling Study

## TL;DR

This study models the risk of catastrophic surgical costs for underserved households in a Florida medical school program, showing how insurance status and neighborhood deprivation affect financial vulnerability.

## Contribution

The study introduces a novel use of the Area Deprivation Index to model and predict catastrophic surgical expenditure risks in low-income communities.

## Key findings

- Households face CSE risks ranging from 7.7% to 88.92%, depending on insurance status and payment burden.
- Higher Area Deprivation Index scores correlate with increased CSE risk, especially for uninsured individuals.

## Abstract

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.