Date of Award
2-24-2026
Embargo Period
5-16-2029
Document Type
Dissertation
Degree Name
Doctor of Health Administration
College
College of Health Professions
First Advisor
Daniel L. Brinton
Second Advisor
Elinor C. G. Borgert
Third Advisor
Charles A. Daly
Abstract
Introduction: Out-of-pocket costs represent a growing financial burden for patients; however, the magnitude of out-of-pocket costs across surgical care settings remains underexamined and under-documented, as many expenses (economic, opportunistic, and otherwise) are not captured within claims data, and impact patients and their families when accessing care. This study examines the impact of the outpatient surgical care setting on out-of-pocket costs when undergoing high-volume outpatient orthopedic surgery in the US.
Methods: We conducted a retrospective, quasi-experimental study analyzing the top 10 outpatient orthopedic surgeries in the 2023 Merative MarketScan Commercial and Medicare research databases, with a quantitative analysis focusing on the impact of site of service (ASC vs. HOPD) on out-of-pocket costs. To control for selection bias, we propensity-matched patients (1:1) to model the propensity for site of service using patient demographic, financial, and clinical variables. We then modeled out-of-pocket costs using a doubly-robust regression to estimate cost differences.
Results: While the total cost of care was 23% higher in the HOPD than in the ASC, the opposite was true for out-of-pocket costs, which were 5% lower in the HOPD than in the ASC.
Conclusions: Financial cost savings associated with the transition from HOPD to ASC have not yet translated into out-of-pocket costs, leading to a lack of awareness and incentives for patients to consider the cost of care. Addressing these gaps will require targeted policy responses to increase systemic awareness and alignment of incentives to reduce costs in orthopedic surgery.
Recommended Citation
Wade, Andrew, "Out-of-Pocket Cost Burden in Outpatient Orthopedic Surgery: Economic Drivers and Opportunities for Alignment" (2026). MUSC Theses and Dissertations. 1094.
https://medica-musc.researchcommons.org/theses/1094
Rights
Copyright is held by the author. All rights reserved.
Included in
Finance and Financial Management Commons, Health and Medical Administration Commons, Health Services Administration Commons, Health Services Research Commons