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Payment under public and private insurance and access to cochlear implants
Steven Garber1, M Susan Ridgely, Melissa Bradley
1RAND, Santa Monica, CA 90407, USA. Steven_Garber@rand.org
Archives of Otolaryngology--Head & Neck Surgery
|October 9, 2002
Summary
Low insurance reimbursement for cochlear implants limits patient access. Many Medicare and Medicaid payment rates do not cover the costs of these life-changing devices and associated services.
Area of Science:
- Otolaryngology
- Health Economics
- Medical Device Reimbursement
Background:
- Cochlear implants offer significant benefits but face limited access in the US, with only ~3000 recipients in 1999.
- Analysis is needed to determine if insurance reimbursement levels are a barrier to cochlear implant adoption.
Purpose of the Study:
- To investigate the relationship between insurance reimbursement rates and cochlear implant access.
- To analyze the cost-effectiveness of cochlear implants in relation to current payment structures.
Main Methods:
- Surveys of physicians, audiologists, hospitals, and state Medicaid agencies were conducted in 1999-2000.
- Data on Medicare/Medicaid payment rates, surgical/audiological time, and device costs were analyzed.
Main Results:
- Medicare and Medicaid reimbursement often fails to cover the costs of aural rehabilitation and surgical services.
- Hospitals incurred significant losses per cochlear implant device under Medicare in 1999.
- Medicaid device payment policies are inconsistent and insufficient in numerous states.
Conclusions:
- Financial incentives, particularly inadequate reimbursement, may hinder cochlear implant access.
- Policy changes in Medicare and Medicaid payment structures are necessary to improve patient access to cochlear implants.