Grants Funded

Abstract

Impact Statement: This project has immediate relevance to plastic surgery patients who present for evaluation of trauma, and become impoverished as a result. While healthcare-mediated bankruptcy is detrimental, we do not know how to identify at risk populations or the role of hospital finance structure on the likelihood of poverty. Data from this study will be used to design interventions that alleviate the financial burden of seeking surgical care in low-income patient populations nationally and internationally. We hope to decrease the likelihood that plastic surgery patients suffer financial hardship due to surgery, and help patients cope with incurred expenses more effectively. This can impact millions of patients across the world who suffer from impoverishing expenditures.

Project Statement: In 2015, the United Nations established the Sustainable Development Goals as a roadmap to catalyze progress and promote equality within nations across the world. One of the core components of these goals was to end poverty from all sources, especially those due to impoverishing medical costs. Despite this plan, over 80 million people continue to become impoverished as a result of surgery alone. Few studies exist that provide generalizable, patient-focused data; as a result, progress within the field has been limited. This proposal represents the work of a multidisciplinary, multi-institution collaboration focused on understanding why patients in India become impoverished after receiving surgery in the setting of trauma. Our long-term goal is to conduct randomized controlled trials using interventions designed to address the burden of healthcare expenditures based on the results of this proposal. Our second long-term goal is to foster bidirectional learning between high-and low-income countries through these studies and interventions given the global nature of this problem. In this study, we prospectively survey patients in India who present to a public, private, and variable-pricing model health system regarding baseline demographic factors and costs associated with surgery. In our first aim, we will quantify the percentage of patients that incur financial hardship as a result of surgery within each health system. We will also use patient demographic factors and clinical data to identify risk factors for financial hardship after surgery. In our second aim, we will interview patients who struggle with expenses after surgery to examine how patient- and hospital-level factors affect one's ability to afford surgery from a qualitative standpoint. The combination of quantitative and qualitative data will inform future studies designed to alleviate the burden of cost on surgical patients.

Biography
Dr. Ranganathan is currently an Assistant Professor within the Division of Plastic and Reconstructive Surgery at Brigham and Women’s Hospital. She serves as the Director of Craniofacial Reconstruction, and focuses on caring for marginalized patient populations. To that end, her clinical practice includes victims of trauma, transgender patients that are not readily accepted into society, and adults with craniofacial anomalies that may be ostracized as a result of their facial appearance and function. She is creating a multidisciplinary center for adults presenting for reconstruction after oncologic resections, congenital anomalies, and trauma in conjunction with surgical and medical teams across the hospital system. From a research standpoint, Dr. Ranganathan is focused on global surgery and implementation science with a specific focus on improving access to care in low- and middle- income countries, optimizing cost-effectiveness in high-income countries, and designing training programs for low resource environments. As she moves forward in her career, Dr. Ranganathan’s primary goal is to contribute to the field of Plastic Surgery as an effective surgeon, educator, and mentor that cultivates opportunity for those most in need.