拒绝索赔:来自弱势种族和种族群体的低收入患者经历了最大的负担
Michal Horný1, Olivia Yu2, Alex Hoagland3
1Michal Horný (mhorny@umass.edu), University of Massachusetts Amherst, Amherst, Massachusetts.
Health affairs (Project Hope)
|June 2, 2025
概括
保险索赔拒绝不成比例地负担弱势患者. 低收入和少数种族患者在挑战拒绝和降低成本方面面临更大的挑战.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生经济学 卫生经济学
- 健康 公平 卫生 公平
背景情况:
- 保险索赔拒绝对患者,特别是那些拥有私人医疗保险的人来说,是一个重要的行政障碍.
- 对抗拒绝要求大量资源,包括对卫生政策和计费的了解,以及解决争端的能力.
研究的目的:
- 分析寻求和获得对保险索赔拒绝的纠正过程中的差异.
- 通过使用一种新的国家数据集,研究各种人口统计和社会经济因素之间的这些差异.
主要方法:
- 利用一个独特的国家数据集,将汇款数据与患者人口统计数据结合起来.
- 进行了描述性分析,以确定索赔拒绝纠正率的模式.
主要成果:
- 来自历史上处于不利地位的种族/民族群体和较低家庭收入 (每年<5万美元) 的患者承受了索赔拒绝的重担.
- 收入较低的患者最不可能被拒绝或降低成本共享.
- 与非西班牙裔白人患者相比,种族少数群体患者的成本共享削减率更高,但每次有争议的拒绝平均节省率更低.
结论:
- 在保险索赔拒绝和解决问题的负担方面存在重大的社会经济和种族差异.
- 需要进行政策干预,以支持纠正错误,防止索赔拒绝,以促进公平获得医疗保健.
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