医疗补助与医疗保险对手部手术赔偿的州差异
Adam P Henderson1, Lane Moore2, Annika Hiredesai3
1Mayo Clinic Alix School of Medicine, 4500 San Pablo Road, Jacksonville, FL.
医疗补助公司对手部手术的报销比医疗保险低18%,因州而异. 工资差异无法解释这些差异,影响了医疗保健的获取.
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
- 外科手术报销分析
背景情况:
- 了解医疗补偿方面的差异对于公平获取至关重要.
- 医疗保险和医疗补助是美国手术服务的主要支付人.
- 报销率的变化可能会影响提供者参与和患者获得护理.
研究的目的:
- 为了比较医疗补助和医疗保险之间的专业服务报销率,用于常见的手术手术程序.
- 量化各个州的报销差异.
- 评估工资调整对补偿率比较的影响.
主要方法:
- 从医疗保险费用表和州医疗补助网站收集了26项手术手术的报销数据.
- 用平均值和美元差额来比较退款率.
- 数据使用医疗保险工资指数进行了调整,以考虑区域工资变化,并分析了变化.
主要成果:
- 在26项手术中,医疗补助补偿金在22项手术中低于医疗保险,平均低于18%.
- 在工资调整后,医疗补助补偿金比医疗保险低29%.
- 医疗保险费率在各州之间差异很小,而医疗补助费率的差异很大,随着工资调整而增加.
结论:
- 与医疗保险相比,手部手术的医疗补助退款要低得多,并且在各州之间变化更大.
- 工资差异无法解释所观察到的报销率差异.
- 低和可变的医疗补助补偿可能会对医疗保健获得负面影响,并引起对联邦资金分配的担忧.
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