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

> **NIH AHRQ K08** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2024 · $153,360

## Abstract

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 outc...

## Key facts

- **NIH application ID:** 10903780
- **Project number:** 5K08HS028817-03
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Nora V. Becker
- **Activity code:** K08 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2024
- **Award amount:** $153,360
- **Award type:** 5
- **Project period:** 2022-09-01 → 2027-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10903780

## Citation

> US National Institutes of Health, RePORTER application 10903780, The cost of illness: The impact of COVID-19 on patient financial outcomes (5K08HS028817-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10903780. Licensed CC0.

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