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Out-of-Pocket Spending for Thumb Carpometacarpal Arthritis: Capitation Matters
Jessica I Billig1,2, Yu-Ting Lu2, Brian P Kelley3
1VA/National Clinican Scholars Program, VA Center for Clinical Management Research, VA, Ann Arbor Healthcare System, Ann Arbor, USA.
Hand (New York, N.Y.)
|February 25, 2020
Summary
Patients with fee-for-service (FFS) insurance face significantly higher out-of-pocket (OOP) costs for thumb arthritis treatment compared to managed care. This financial burden highlights the need for cost-sharing considerations in patient care.
Area of Science:
- Orthopedic Surgery
- Health Economics
- Health Services Research
Background:
- Increasing patient responsibility for direct medical expenditures and rising out-of-pocket (OOP) expenses can hinder access to care and impact treatment adherence.
- Thumb carpometacarpal (CMC) joint arthritis is a common condition necessitating surgical and presurgical interventions, often involving significant patient costs.
Purpose of the Study:
- To investigate the impact of different insurance models, specifically capitation, on patient out-of-pocket expenses for thumb CMC arthritis treatment.
- To compare OOP costs between fee-for-service (FFS) and managed care (MC) insurance plans, including Medicare beneficiaries.
Main Methods:
- A retrospective cohort study analyzed patients diagnosed with thumb CMC arthritis who underwent surgery between 2009 and 2016.
- Sociodemographic data, total costs, and OOP expenses were collected at surgery and two years prior.
- Patients were stratified by insurance type: FFS, MC, Medicare-MC, and Medicare-FFS, with capitated plans included in MC and Medicare-MC groups. Generalized linear regression was used to analyze OOP expenses association with insurance type.
Main Results:
- The study included 7780 FFS, 953 MC, 2136 Medicare-FFS, and 265 Medicare-MC patients.
- Total costs did not differ significantly between FFS and MC ($7281 vs. $7306, P = .73) or between Medicare-FFS and Medicare-MC ($6663 vs. $6183, P = .19).
- OOP expenses were substantially higher for FFS ($952) and Medicare-FFS ($343) compared to MC ($434) and Medicare-MC ($232) (P < .01). Adjusted regression showed MC, Medicare-FFS, and Medicare-MC plans had 21%-46% of the OOP expenses of FFS plans (P < .01).
Conclusions:
- Fee-for-service (FFS) and Medicare-FFS insurance plans result in significantly higher out-of-pocket expenses for thumb CMC arthritis treatment, despite comparable total costs.
- As healthcare costs shift towards patients, providers must consider cost-sharing implications when recommending treatments to mitigate financial burdens.
