Assessment of Out-of-Pocket Spending for COVID-19 Hospitalizations in the US in 2020.
Assessment of Out-of-Pocket Spending for COVID-19 Hospitalizations in the US in 2020.
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评估2020年美国共同19日住院的自付支出。
DOI：
10.1001/jamanetworkopen.2021.29894
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发表时间：
2021-10-01
影响因子：
13.8
通讯作者：
Becker NV
中科院分区：
文献类型：
--
作者：
Chua KP;Conti RM;Becker NV
这项横断面研究评估了2020年拥有私人保险和联邦医疗保险优势计划（Medicare Advantage）的患者因新冠住院的自付费用。
2020年美国新冠患者住院的费用是多少？
在这项对2020年4075例新冠住院病例的横断面研究中，71.2%的私人保险患者和49.1%的联邦医疗保险优势计划患者对任何与住院相关的服务（包括临床医生开具的账单）都有费用分担；4.6%的私人保险患者和1.3%的联邦医疗保险优势计划患者对医院开具的设施服务费用有分担，平均自付费用分别为3840美元和1536美元。
研究结果表明，如果保险公司允许费用分担豁免到期，新冠住院的自付费用可能会很高。
2020年许多保险公司免除了新冠住院的费用分担。然而，如果患者的保险计划没有实施豁免，或者豁免没有涵盖所有与住院相关的护理，患者可能仍会收到账单。对2020年新冠住院自付费用的评估可能会显示出如果保险公司允许豁免到期患者可能承受的经济负担，就像2021年许多保险公司所做的那样。
为了估算2020年美国新冠住院的自付费用。
这项横断面研究使用了来自艾昆纬医药数据学术加强版（IQVIA PharMetrics Plus for Academics）数据库的数据，该数据库是一个全国性的理赔数据库，涵盖了770万私人保险患者和100万联邦医疗保险优势计划患者，涉及2020年3月至9月私人保险和联邦医疗保险优势计划患者的新冠住院情况。
平均总自付费用，定义为医院开具的设施服务（例如住宿费）以及临床医生和辅助服务提供者开具的专业和辅助服务（例如临床医生住院评估和管理、救护车运输）的自付费用总和。
分析包括4075例住院病例；2091例（51.3%）为男性患者，患者的平均（标准差）年龄为66.8（14.8）岁。在这些住院病例中，1377例（33.8%）为私人保险患者。在1377例私人保险患者的住院病例中，有981例（71.2%）报告了设施服务、专业和辅助服务或两者的自付费用，在2968例联邦医疗保险优势计划患者的住院病例中，有1324例（49.1%）报告了相关自付费用。在这些住院病例中，私人保险患者的平均（标准差）总自付费用为788美元（1411美元），联邦医疗保险优势计划患者为277美元（363美元）。相比之下，在63例私人保险患者的住院病例（4.6%）和36例联邦医疗保险优势计划患者的住院病例（1.3%）中报告了设施服务的自付费用。在这些住院病例中，私人保险患者的平均（标准差）总自付费用为3840美元（3186美元），联邦医疗保险优势计划患者为1536美元（1402美元）。2.5%的私人保险患者住院的总自付费用超过4000美元，而联邦医疗保险优势计划患者住院这一比例为0.2%。
在这项横断面研究中，2020年因新冠住院的患者很少收到医院提供的设施服务账单，这表明大多数患者由实施费用分担豁免的保险公司承保。然而，许多患者收到了专业和辅助服务的账单，这表明保险公司的费用分担豁免可能没有涵盖所有与住院相关的护理。对收到设施服务账单的患者的高费用分担表明，对于保险公司允许豁免到期的患者来说，自付费用可能会很高。
This cross-sectional study assesses out-of-pocket spending by privately insured and Medicare Advantage patients for COVD-19 hospitalizations in 2020. How much were patients billed for COVID-19 hospitalizations in the US in 2020? In this cross-sectional study of 4075 COVID-19 hospitalizations in 2020, 71.2% of privately insured patients and 49.1% of Medicare Advantage patients had cost sharing for any hospitalization-related service, including those billed by clinicians; 4.6% of privately insured and 1.3% of Medicare Advantage had cost sharing for facility services billed by hospitals, with mean out-of-pocket spending of $3840 and $1536, respectively. The findings suggest that out-of-pocket spending for COVID-19 hospitalizations may be substantial if insurers allow cost-sharing waivers to expire. Many insurers waived cost sharing for COVID-19 hospitalizations during 2020. Nonetheless, patients may have been billed if their plans did not implement waivers or if waivers did not capture all hospitalization-related care. Assessment of out-of-pocket spending for COVID-19 hospitalizations in 2020 may show the financial burden that patients may experience if insurers allow waivers to expire, as many chose to do during 2021. To estimate out-of-pocket spending for COVID-19 hospitalizations in the US in 2020. This cross-sectional study used data from the IQVIA PharMetrics Plus for Academics Database, a national claims database representing 7.7 million privately insured patients and 1.0 million Medicare Advantage patients, regarding COVID-19 hospitalizations for privately insured and Medicare Advantage patients from March to September 2020. Mean total out-of-pocket spending, defined as the sum of out-of-pocket spending for facility services billed by hospitals (eg, accommodation charges) and professional and ancillary services billed by clinicians and ancillary providers (eg, clinician inpatient evaluation and management, ambulance transport). Analyses included 4075 hospitalizations; 2091 (51.3%) were for male patients, and the mean (SD) age of patients was 66.8 (14.8) years. Of these hospitalizations, 1377 (33.8%) were for privately insured patients. Out-of-pocket spending for facility services, professional and ancillary services, or both was reported for 981 of 1377 hospitalizations for privately insured patients (71.2%) and 1324 of 2968 hospitalizations for Medicare Advantage patients (49.1%). Among these hospitalizations, mean (SD) total out-of-pocket spending was $788 ($1411) for privately insured patients and $277 ($363) for Medicare Advantage patients. In contrast, out-of-pocket spending for facility services was reported for 63 hospitalizations for privately insured patients (4.6%) and 36 hospitalizations for Medicare Advantage patients (1.3%). Among these hospitalizations, mean (SD) total out-of-pocket spending was $3840 ($3186) for privately insured patients and $1536 ($1402) for Medicare Advantage patients. Total out-of-pocket spending exceeded $4000 for 2.5% of privately insured hospitalizations compared with 0.2% of Medicare Advantage hospitalizations. In this cross-sectional study, few patients hospitalized for COVID-19 in 2020 were billed for facility services provided by hospitals, suggesting that most were covered by insurers with cost-sharing waivers. However, many patients were billed for professional and ancillary services, suggesting that insurer cost-sharing waivers may not have covered all hospitalization-related care. High cost sharing for patients who were billed by facility services suggests that out-of-pocket spending may be substantial for patients whose insurers have allowed waivers to expire.
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