The cost of illness: The impact of COVID-19 on patient financial outcomes

PROJECT SUMMARY/ABSTRACT Candidate: Nora Becker, MD, PhD, is a primary care physician, health economist, and early career health services researcher. Her long-term career objective is to become an independent physician-investigator and national expert on the impact of illness on financial outcomes for women and vulnerable populations in order to inform policies to reduce disparities and protect patients from financial harm. Research Context: The financial consequences of illness-termed "financial toxicity"-are important patient outcomes. Financial toxicity has two components, objective financial burden and subjective financial distress, but the lack of available data has made it difficult to measure objective financial burden. Further, the existing measures of subjective financial distress are limited and heterogeneous. The SARS-CoV-2 (COVID-19) pandemic has made it even more important to develop new ways to estimate and understand the magnitude of financial toxicity following acute illness. Specific Aims: 1) Identify patient subgroups at highest risk for objective financial burden after COVID-19 infection; 2) Estimate the causal effect of COVID-19 infection on objective financial burden independent of economic trends during the pandemic and describe heterogeneity in outcomes by patient subgroup; 3) Assess subjective financial distress related to COVID-19 infection. Research Plan: In Aims 1 and 2, Dr. Becker will perform a novel data linkage of commercial credit report data, Blue Cross Blue Shield of Michigan (BCBSM) insurance claims, and zip code-level social determinants of health. In Aim 1 she will use machine learning methods to identify which patients are at highest risk of poor credit report outcomes after COVID-19 infection, and in Aim 2 she will use advanced econometric methods to estimate the effect of COVID-19 infection on credit report outcomes, independent of overall economic trends during the pandemic, and describe heterogeneity in outcomes by patient subgroups. In Aim 3, Dr. Becker will adapt, pilot, and administer a new COVID-19-specific survey measure of subjective financial distress. Together, these aims will comprehensively estimate the financial toxicity of COVID-19 infection. Career Development Plan: Dr. Becker will develop expertise in 1) machine learning methods, 2) newly developed advanced econometric methods, 3) primary data collection and survey methods, and 4) leadership and communication skills to disseminate her work effectively to inform policy change. Dr. Becker's training will be supported by close mentorship, advanced didactic coursework, participation in career development activities, and engagement with media and policymakers to share the results of her research. Research Goals: The goal of this research is to identify the financial effects of COVID-19 infection, and which patients are most at risk of financial harm following infection, to inform the development of policies to reduce disparities in financial outcomes and better protect patients from the financial consequences of illness.