Out-of-pocket Costs and Total Payments for Common Congenital Hand Difference Procedures.

Abstract

Background: Healthcare costs in the United States continue to rise, shifting an increasing financial burden onto patients. Families of children requiring surgery for congenital hand differences (CHDs) are particularly vulnerable, yet there are limited data on the costs associated with these procedures, hindering efforts to address healthcare inequities.

Methods: Using data from the MarketScan Commercial Claims database from 2016 to 2022, we identified children aged 5 years or younger who underwent surgery for 5 common CHD conditions. Total payments and out-of-pocket payments, including deductibles, copayments, and coinsurance, were collected. Linear regression was used to analyze trends. All costs were inflation-adjusted to 2022 dollars.

Results: The study included 3070 cases from 2016 to 2022, with trigger thumb release (70%) and syndactyly repair (16%) being the most common procedures. Median total payment across all procedures was $3763 (interquartile range [IQR] $4030), whereas median out-of-pocket payment was $544 (IQR $1376). Pollicization had the highest median total payment ($11,882 [IQR $16,915]), whereas constriction ring syndrome had the lowest ($2080 [IQR $3720]). High-deductible health plans were associated with higher total and out-of-pocket costs. Regional disparities were significant, with the Northeast having the highest total payments. Procedures performed in ambulatory surgical centers were associated with lower total payments but similar out-of-pocket costs compared with hospital settings.

Conclusions: Children undergoing CHD surgery face substantial financial burdens, with significant variability in costs by procedure, region, insurance plan type, and provider specialty. Policymakers should prioritize measures to mitigate out-of-pocket costs and address regional and specialty-driven cost disparities to ensure equitable access to care.