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In Crisis of Abundance: Rethinking How We Pay for Health Care, economist Arnold Kling argues that the way we finance health care matches neither the needs of patients nor the way medicine is practiced. The availability of \"premium medicine,\" combined with patients who are insulated from costs, means Americans are not getting maximum value per dollar spent.

INTRODUCTION Older adults with dementia incur considerable out‐of‐pocket (OOP) health care expenses, but it is unclear how their financial burden differs by dementia stage. METHODS We identified 2939 respondents aged ≥65 with dementia in the 2018 Health and Retirement Study, representing 9.8 million individuals on weighted analysis. We grouped respondents into four severity stages and examined their OOP expenditures, prevalence of financial risk (i.e., catastrophic or impoverishing levels of health care spending), and factors associated with financial risk. RESULTS Individuals with severe dementia had significantly higher OOP costs, with 21% experiencing catastrophic expenditures and 12% falling below poverty thresholds due to these costs. Regression analyses indicated nursing home residence, poor subjective health, advanced age, and other factors are associated with an increased odds of financial risk. DISCUSSION Financial risk increases in advanced dementia stages, likely reflecting more complex care needs and poorer overall health. Highlights Out‐of‐pocket health care costs increase with dementia severity. Twenty‐one percent of people with severe dementia spend at least 40% of their income on health care. The risk of impoverishment from health care costs increases in severe dementia. Care needs, poor health, and nursing home residence may contribute to financial risk.

Introduction Men with newly diagnosed prostate cancer often appropriately elect for either immediate treatment or conservative management. The out‐of‐pocket costs they face vary by management strategy, with immediate treatment often superseding those of conservative management, potentially influencing patient decisions. We estimated the anticipated out‐of‐pocket costs that commercially insured men with newly diagnosed prostate cancer face and measured their association with immediate treatment. Methods From MarketScan, we identified men with newly diagnosed prostate cancer from 2010–2020. Separately, using actual out‐of‐pocket costs (summing deductible, copay, coinsurance) among patients undergoing arthroscopic meniscal repair (n = 383,187), we derived regression coefficients for patient‐level variables (e.g., health plan type) that inform their financial liability. We applied these coefficients to men with prostate cancer and estimated their predicted out‐of‐pocket costs, our main exposure. We sorted patients into quartiles and used logistic regression to calculate adjusted probabilities of immediate treatment (versus conservative management). Results We identified 58,206 men with prostate cancer and rank ordered them by predicted out‐of‐pocket cost. Approximately 12% of men had a predicted out‐of‐pocket cost of zero, and among those with non‐zero cost sharing, the median out‐of‐pocket cost was$350 (IQR: $ 275, $486). Across quartiles of predicted out‐of‐pocket costs, adjusted percentages of immediate treatment were in a narrow range between 77.8% (95% CI: 76.8%, 78.8%) for Quartile 1% and 78.6% (95% CI: 77.7%, 79.5%) for Quartile 4. Conclusion Among commercially insured men with prostate cancer, predicted out‐of‐pocket costs varied substantially. However, the choice of management, immediate treatment or conservative management, appears insensitive (i.e., inelastic) to patient anticipated financial liability.

Objective. This study aimed to quantify the out-of-pocket (OOP) costs and perceived financial burden among Australian men with localised prostate cancer in the first 6 months after diagnosis, by primary management option. Methods. This cost-analysis quantified OOP costs using administrative claims data and self-reported survey data. Financial burden was assessed using the COmprehensive Score for financial Toxicity–Functional Assessment of Chronic Illness Therapy (COST-FACIT) tool. Participants were recruited into a randomised control trial from public or private treatment centres in Victoria and Queensland. Generalised linear models were used to predict OOP costs and COST-FACIT scores. Results. Median total OOP costs within 6 months of diagnosis for 256 Australian patients with localised prostate cancer was A $1172 (A$ 343–2548). Up to 50% of the sample reported A$0 costs for most medical services. Compared with those managed with active surveillance, men having active treatment had 6.4 (95% CI: 3.2–12.7) times greater total OOP costs. Management option, higher Gleason score at diagnosis and having multiple comorbidities were significant predictors of higher OOP costs. Overall high scores on the COST-FACIT indicated low levels of financial burden for the entire sample. Conclusion. Largely attributable to being managed with active surveillance, Australian men diagnosed with localised prostate cancer reported relatively low OOP costs and financial burden in the first 6 months post-diagnosis. Together with clinical outcomes, clinicians can use this up to date evidence on costs and perceived financial burdens to assist localised prostate cancer patients and their families make informed decisions about their preferred management option.

Background Out‐of‐pocket costs (OOPC) associated with treatment have significant implications on quality of life and survival in cancer patients. Head and neck cancer patients face unique treatment‐related challenges, but to date OOPC have been understudied in this population. Aims This study aims to identify and measure OOPC for patients with head and neck cancer (HNC) in Ontario. Methods HNC patients between 2015 and 2018 at Princess Margaret Cancer Centre in Toronto were recruited. Participants completed OOPC questionnaires and lost income questions during radiation, post‐surgery, and 3, 6, 12, and 24 months after completion of treatment. Associations between OOPC and treatment modality and disease site were tested with multivariable hurdle regression. Results A total of 1545 questionnaires were completed by 657 patients. Median estimated OOPC for the total duration of treatment for participants undergoing chemoradiation was$1452 [$ 0–14 616], for surgery with adjuvant radiation or chemoradiation (C/RT) was$1626, for radiation therapy alone was $ 635, and for surgery alone was$360. The major expenses for participants at the mid‐treatment time‐point was travel (mean $ 424, standard error of the mean [SEM]$34) and meals, parking, and accommodations (mean $ 617, SEM $67). In multivariable analysis, chemoradiation, surgery with C/RT, and radiation were associated with significantly higher OOPC than surgery alone during treatment (791% higher, p < .001; 539% higher, p < .001; 370% higher, p < .001 respectively) among patients with non‐zero OOPC. Participants with non‐zero OOPC in the laryngeal cancer group paid 49% lower OOPC than those with oropharyngeal cancers in adjusted analysis (p = .025). Conclusions Patients undergoing treatment for HNC pay significant OOPC. These costs are highest during treatment and gradually decrease over time. OOPC vary by patient demographics, clinical factors, and, in particular, treatment modality.

Introduction Out‐of‐pocket (OOP) healthcare costs remain prohibitive in low‐resource settings, often pushing families into poverty. Universal health coverage (UHC) goals emphasise protecting households from financial hardship due to medical expenses. Objectives This study examines which socioeconomic and demographic factors predict the amount of free mental healthcare support received by applicants. Methodology We conducted a cross‐sectional analysis. Descriptive statistics summarised 286 applicant profiles (e.g., 66.8% female and 49% aged 28–48). Spearman and Pearson correlations assessed the relationship between applicants’ monthly treatment‐related OOP costs and aid received (log‐transformed values). A multiple linear regression was then fitted with log (free care amount) as the outcome and predictors including age group, sex, occupation, marital status, income source, reason for support and log (monthly treatment‐related OOP cost). Results The applicant profile was predominantly young, unmarried, female students relying on parental support, seeking aid mainly for financial hardship. Spearman's ρ showed a small but significant positive correlation between treatment cost and aid amount, confirmed by Pearson's r after log transformation (r ≈ 0.17, p < 0.01). In regression analysis, higher treatment cost strongly predicted more free aid (β ≈ 0.18, p = 0.003), indicating that donors allocate more resources to costlier cases. Households supported by a spouse's income received significantly less aid (β ≈ −0.93, p = 0.038), suggesting that more stable households needed less assistance. Parental income support was marginally associated with reduced aid (p ≈ 0.07), whereas student status showed a borderline positive effect (p ≈ 0.08). Conclusion This study highlights that free mental healthcare support in a resource‐poor setting is driven primarily by treatment cost and applicants’ perceived need. Those with higher medical expenses receive more aid, aligning with the principle of need‐based assistance. De‐identified administrative records of 286 mental health aid applicants in Bangladesh are analyzed to examine need‐based aid allocation. Higher out‐of‐pocket treatment costs are associated with larger aid awards. Applicants with spouses as primary earners receive substantially less aid, while students or those without stable income receive slightly more. Financial hardship appears to influence aid allocation more strongly than stated mental health need.

Little is known about out‐of‐pocket (OOP) costs incurred for medical and health needs by rural breast cancer survivors and what factors may be associated with higher OOP costs and the associated economic burden. Data were examined for 432 survivors participating in the Rural Breast Cancer Survivor Intervention trial. OOP costs were collected using the Work and Finances Inventory survey at baseline and four assessments every 3 months. Mean and median OOP costs and burden (percent of monthly income spent on OOP costs) were reported and factors associated with OOP costs and burden identified with generalized linear models fitted with over‐dispersed gamma distributions and logarithmic links (OOP costs) and with beta distributions with logit link (OOP burden). OOP costs per month since the end of treatment were on average$232.7 (median $ 95.6), declined at the next assessment point to$186.5 (median $ 89.1), and thereafter remained at that level. Mean OOP burden was 9% at baseline and between 7% and 8% at the next assessments. Factors suggestive of contributing to higher OOP costs and OOP burden were the following: younger age, lower income, time in survivorship from diagnosis, and use of supportive services. OOP costs burden rural breast cancer survivors, particularly those who are younger and low income. Research should investigate the impact of OOP costs and interventions to reduce economic burden. Among 432 rural breast cancer survivors who had completed treatment, out‐of‐pocket costs related to cancer were more than $180 per month over a 1‐year period, burdening survivors with low income disproportionately. Further research is warranted to understand the consequences of this burden and develop the means to reduce its impact.

This systematic review examined peer‐reviewed literature published from 2010 to 2020 to investigate the health care system costs, hidden out‐of‐pocket expenses and quality of life impact of surgical site infections (SSIs) and to develop an overall summary of the burden they place on patients. SSI can significantly impact patients' treatment experience and quality of life. Understanding patients' SSI‐related burden may assist in developing more effective strategies aimed at lessening the effects of SSI in financial and well‐being consequences. Peer‐reviewed articles on adult populations (over 18 years old) in orthopaedic elective hip and knee surgeries published from 2010 to 2020 were considered. Only publications in English and studies conducted in high‐income countries were eligible for inclusion. A search strategy based on the MESH term and the CINAHL terms classification was developed. Five databases (Scopus, EMBASE, CINAHL, Medline, Web of Science) were searched for relevant sources. Reviewers categorised and uploaded identified citations to Covidence and EndNoteX9. Reviewers will assess article titles, s and the full text for compliance with the inclusion criteria. Ongoing discussions between reviewers resolved disagreements at each selection process stage. The final scoping review reported the citation inclusion process and presented search results in a PRISMA flow diagram. Four main themes were extracted from a thematic analysis of included studies (N = 30): Hospital costing (n = 21); Societal perspective of health system costing (n = 2); Patients and societal well‐being (n = 6) and Epidemiological database and surveillance (n = 22). This systematic review has synthesised a range of themes associated with the overall incidence and impact of SSI that can inform decision making for policymakers. Further analysis is required to understand the burden on SSI patients.