National Trends in Utilization and Expenditures for Plastic Surgery From 2002 to 2022: A Cross-Sectional Study

Shifting patterns in the financing of plastic surgery are not fully understood. We analyze payer trends for office and outpatient plastic surgery visits from 2002 to 2022.

We investigated office-based and hospital outpatient department plastic surgery visits in the Medical Expenditure Panel Survey, a national dataset of healthcare usage and expenditures. During the study period (2002-2022), we calculated the yearly median amount of money charged and paid per visit, the distribution of payer type expenditures, and the mean payment-to-charge ratio per visit. Dollar amounts were inflation-adjusted to 2022 estimates.

From 2002 to 2022, there were 5824 office-based plastic surgery visits and 850 outpatient department plastic surgery visits, representing 71,597,980 and 10,589,575 total visits, respectively. For office-based visits, the number of visits declined across the study period from 3,982,280 to 1,418,032 (-64.4%), the median (IQR) payment per visit increased from $119.06 ($188.49) to $263.48 ($721.35) (+121.3%), and the median (IQR) payment-to-charge ratio decreased from 0.71 (0.43) to 0.47 (0.45) (-33.8%). Payments were primarily private insurance (37.6%) and out-of-pocket (36.0%). For outpatient department visits, the median (IQR) payment-to-charge ratio also decreased significantly from 0.56 (0.44) to 0.35 (0.45) (-37.1%); median (IQR) payment per visit was $1587.93 ($1287.80) without significant changes over time. Most expenditures were from private insurance (58.5%), then self-pay (17.8%), and Medicare (11.7%).

National trends in plastic surgery expenditures show decreasing payment-to-charge ratios for both office and outpatient department settings. However, the payer mix driving these trends differs by practice setting. Limitations of the study include survey-based data, a small sample size, and the exploratory nature of the study with limited statistical analysis. Further research is warranted to uncover factors that may account for these findings and their implications.