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No Surprises Act の後の患者の医療費:差異に関する準実験的研究

Michael Liu^1,2, Kushal T Kadakia³, Stephen A Mein^1,4

¹Section of Health Policy, Richard A and Susan F Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.

BMJ (Clinical research ed.)

|August 27, 2025

まとめ

驚くことのない法案 (No Surprises Act,NSA) は,サプライズ・ビリング・プロテクションを得ている民間保険の成人の医療費を大幅に削減しました. 保険料と高負担の医療費は変わらず,さらなる政策措置の必要性を示しています.

科学分野:

健康経済
健康政策
消費者保護

背景:

No Surprises Act (NSA) は2022年に施行され,驚異的な医療費から人々を保護するためです.
医療費に対するNSAの財政的影響を理解することは,その効果を評価する上で極めて重要です.

研究の目的:

NSAの導入後の民間保険の直接購入による米国の成人の医療費の変化を推定する.
NSAのサプライズ・ビリング・プロテクションが医療費に与える影響を評価する

主な方法:

差異の差異に関する準実験的な研究設計が採用された.
米国24州 (2019年-2024年) のデータを分析し,NSA保護 (介入) を獲得した州と,すでに包括的な保護 (コントロール) を獲得している州の成人を比較した.
インフレ調整した自費支出,保険料,高額な医療費が主な結果の指標でした.

主要な成果:

自費支出はNSA後の介入国では16.5%減少し,対照国では1.9%増加した.
介入国と対照国では,自費支出が18.0%減少した.
介入群と対照群の保険料支出や高負担医療費の有意な差異は見つかりませんでした.

結論:

民間保険に加入した個人の医療費を大幅に削減し意外な請求権の保護を得ました
保険料のコストと高額な医療費は,NSAに起因する重大な変化を示さなかった.
米国における医療関連の財政的負担を軽減するために,さらなる政策介入が必要である.

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