烧伤之外:评估保险支持烧伤伤后的化品重建
Anastasiya Ivanko1, Athena Hoppe1, Jason P Heard2
1Louisiana State University Health and Sciences Center, New Orleans, LA.
概括
大多数主要的医疗保险公司拒绝在烧伤后进行化品重建 (CR) 的保险,即使是显著功能障碍 (FI). 这限制了烧伤幸存者的必要后期护理,阻碍了康复和生活质量.
科学领域:
- 医学经济学 医学经济学
- 整形外科 整形外科 整形外科
- 医疗保险政策 医疗保险政策
背景情况:
- 烧伤导致长期挑战,包括痕,影响心理,生理和生物机械健康.
- 现有的烧伤痕管理干预措施往往由于保险覆盖不足而受到限制.
- 化品重建 (CR) 是全面烧伤护理的关键方面,但其可访问性往往受到限制.
研究的目的:
- 检查主要医疗服务提供商在烧伤后进行化品重建 (CR) 的保险政策.
- 识别不同提供商和州的与烧伤相关的CR干预保险覆盖的不一致性和局限性.
- 倡导政策改革,确保平等获得必要的烧伤后重建护理.
主要方法:
- 对五家主要医疗保险公司 (UnitedHealth Group,Elevance Health,Humana,CVS/Aetna,Centene Corporation) 的保险政策进行了全面审查.
- 政策分析了针对烧伤的侵入性和非侵入性CR干预措施的覆盖范围.
- 系统地从特定州的保险文件中收集数据,使用微软Excel进行分析.
主要成果:
- 没有一家经过审查的大型保险公司为CR提供保险,除非有显著功能障碍 (FI) 的记录.
- 对CR的覆盖范围在各提供商和各州之间是分散的和不一致的,记录FI的例外是有限的.
- 联合健康集团,Humana和CVS/Aetna提供全国范围的覆盖,但将CR限制在已记录FI的病例上,而Elevance Health的覆盖范围有限,Centene提供个案审查.
结论:
- 目前的保险政策为烧伤幸存者进行必要的化品重建造成了重大障碍.
- 缺乏标准化和公平的保险加剧了从烧伤中恢复过来的个人所面临的身体和情感负担.
- 政策改革迫切需要确保烧伤幸存者能够获得必要的CR,以改善恢复和生活质量.
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