Grants Funded

Abstract

Project Summary: One in seven hundred children are born with an orofacial cleft each year in the United States. Children with cleft lip and palate begin reconstruction during infancy, and require longitudinal, multidisciplinary surgical care through young adulthood. As such, children with cleft lip and palate require high healthcare utilization. While most states have safeguards in place to provide government assistance through Medicaid and Children's Health Insurance Program (CHIP) for those that qualify and even additional supplemental plans for children with congenital anomalies, those with private insurance may not be able to afford enrollment in supplemental programs. Many private insurance plans have high deductibles and increased cost-sharing in the form of copayments and co-insurance, leaving patients with variable out of pocket costs. This can result in burdensome medical expenditures for families with high healthcare utilization. Currently, little is known about the financial impact of cleft related care on caregivers and families. Prior studies have demonstrated that cleft related care can result in substantial burden, such as caregivers' need for time off work, transportation costs, and the cost of non-surgical aspects of cleft care, such as dental and orthodontic care as well as speech and language support. In this one year project, we will examine out of pocket costs associated with common cleft related surgical procedures based on insurance type and identify protective or predisposing factors associated with increased out of pocket costs. Additionally, we will compare the costs of primary lip repair and alveolar cleft bone grafting on an inpatient versus outpatient basis. Finally, we will qualitatively assess caregiver-reported financial burden associated with cleft related care for families with children with cleft lip and palate. Utilizing both qualitative methods as well as administrative claims data will provide a comprehensive assessment of the costs associated with cleft surgical care and its financial burden on families. This work will serve to identify strategies to mitigate the burden of cleft care on families and inform future health policy.

Impact Statement: The findings from this proposal will provide important evidence to inform future efforts to design insurance plans that ease the burden of cleft related care and improve access to care for families. In addition, this project will provide training in administrative claims analytic techniques, qualitative methodology, and the drivers of financial health and toxicity related to healthcare.

Biography
Dr. Alexandra Luby is a third year plastic surgery resident at the University of Michigan. Originating from Ohio, she received a Bachelors of Chemical Engineering and Masters of Bioengineering at University of Dayton prior to medical school at the University of Toledo College of Medicine. With an early interest in Plastic Surgery, she sought opportunities for further exposure to the field. As a first year medical student, she began working in the Craniofacial Research Laboratory at the University of Michigan. Following her third year of medical school, she pursued a one year research fellowship to continue basic and translational science focused on improving reconstructive outcomes after radiotherapy. As a resident at Michigan, she has gained further exposure to high level clinical research and has become increasingly interested in health services research to improve the care of craniofacial surgery patients. She sees research as an avenue to improve patient care beyond the reach of a single surgeon, as it has the potential to impact lives and healthcare delivery around the world. She is looking forward to her dedicated academic development time during residency, as she believes it will be instrumental in achieving her long-term career goal of becoming an academic craniofacial surgeon and an independent investigator.