门诊外科手术市场的定价和保险网络
Xiaoxi Zhao1, Christopher M Whaley, Elizabeth L Munnich
1RAND Corporation, 1776 Main St, Santa Monica, CA 90401.
The American journal of managed care
|October 27, 2025
概括
患者通过选择网络设施进行门诊手术来节省资金. 保险公司受益于越来越多地使用门诊外科中心 (ASC),降低了整体医疗保健支出.
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
- 外科手术的结果
背景情况:
- 商业保险对门诊手术的医疗保健费用产生重大影响.
- 护理地点和保险网络状态的变化会影响外科手术的定价.
研究的目的:
- 分析护理地点和保险网络如何影响常见成人门诊手术的价格差异.
- 为了比较不同保险网络内的门诊外科中心 (ASC) 与医院门诊部门 (HOPD) 的成本.
主要方法:
- 一项观察性研究利用了50个州的商业医疗索赔数据样本.
- 对比了保险公司支付,患者自付费用和四次常见门诊手术的余额计费.
- 根据护理地点 (ASC与HOPD) 和保险网络状态 (网络内与网络外) 分析数据.
主要成果:
- 与网络内ASC相比,保险公司对网络之外的ASC支付的额外费用为32%,对HOPD (网络内和网络外) 支付的额外费用为110%.
- 患者在网络内HOPD的自付费用比网络内ASC高出186美元.
- 网络内设施的患者成本共享率通常低于网络外设施.
结论:
- 通过选择网络设施,患者可以从经济上受益,而不管是哪个护理地点.
- 保险公司越来越多地使用ASC可以节省大量成本.
- 通过保险模式调整患者和保险公司的激励措施,可以促进ASC的使用,并减少整体门诊手术支出.
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