在重症监护室 (ICU) 住院住院时的意外收费
Sneha Kannan1,2, Zirui Song2,3
1Division of Pulmonary/Critical Care, Massachusetts General Hospital, Boston, MA 02114, United States.
Health affairs scholar
|March 15, 2024
概括
重症监护室 (ICU) 余额账单是常见的,影响了三分之一的患者. "无惊喜法"现在禁止这种行为,这可能会改变医疗保健成本和提供者与保险公司的谈判.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健政策 医疗保健政策
- 关键护理医学 关键护理医学
背景情况:
- 重症监护室 (ICU) 的利用率和相关成本正在上升.
- 由ICU专家 (密集治疗师) 支付余额,一直是患者和医疗提供者的重大财务负担.
- 有限的数据存在于ICU的余额计费的流行和财务影响.
研究的目的:
- 量化"无惊喜法"之前的ICU住院病人的余额计费的程度.
- 评估余额计费对ICU环境中的患者和提供者的潜在经济影响.
- 了解"无惊喜法"对ICU护理和医疗保健经济学的影响.
主要方法:
- 对MarketScan商业 (IBM) 数据库对2010-2019年ICU住院病人的分析.
- 住院治疗的分类是完全在网络内,完全在网络外和"混合" (包含两者).
- 检查网络之外的支出,特别是在ICU内,并估计可信的余额账单金额.
主要成果:
- 在2010年至2019年期间",混合"住院 (部分网络之外) 的比例从26%增加到33%.
- 超过一半的"混合"ICU住院病例包括在ICU内提供的网络之外的服务.
- 大约三分之一的ICU住院病例涉及合理的余额计费,平均每例数千美元,其中11%的ICU总支出是网络之外的.
结论:
- 在"无惊喜法"之前,ICU护理的很大一部分涉及网络之外的成本和潜在的余额计费.
- 预计"无惊喜法"禁止平衡计费将影响提供商的收入和与保险公司的谈判.
- 网络状态和定价的潜在变化可能会影响患者获得ICU护理的机会和性质.
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