与网络内初级外科医生和设施进行选择性手术的私人保险患者的网络外账单
Karan R Chhabra1,2,3,4, Kyle H Sheetz2,5, Ushapoorna Nuliyalu2
1National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
JAMA
|February 12, 2020
概括
许多接受选择性手术的患者会从网络之外的医生那里收到意外的医疗费用. 即使使用网络供应商, 这些意外的网络外账单也会使患者花费数千美元.
科学领域:
- 健康经济学
- 医疗账单
- 有耐心的财务经验
背景情况:
- 有私人保险的患者可能会从未选择的临床医生那里收到意想不到的网络外账单.
- 这一问题在选择性外科手术中尤为重要,患者可以选择网络外科医生和设施,但仍然需要从其他提供者那里收取网络外费.
研究的目的:
- 评估常见的选择性外科手术网络外收费的发生率和财务影响.
- 确定与这些意外医疗费用相关的因素.
主要方法:
- 对美国一家大型商业保险公司 (347,356名患者) 索赔数据的回顾性分析.
- 审查了2012年1月至2017年9月期间进行的7项共同选修业务.
- 评估的网络外账单和估计的潜在余额账单.
主要成果:
- 20.5%的选择性手术发作导致网络外账单,平均每发作2011美元.
- 外科助理 (37%) 和麻醉师 (37%) 的账单常见.
- 医疗保险交换计划中的患者和经历手术并发症的患者有更高的意外账单风险.
结论:
- 对于有商业保险的患者来说, 选择性手术的很大一部分涉及网络之外的账单.
- 意外医疗收费仍然是一个重大问题,即使在网络护理中也会影响患者的财务状况.
- 诸如保险计划类型和手术并发症等因素增加了这些意外成本的可能性.
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