Out-of-Pocket Spending on Common Operations Among the Commercially Insured.
Out-of-Pocket Spending on Common Operations Among the Commercially Insured.
复制标题
商业投保人在共同业务上的自付费用。
DOI：
10.1097/sla.0000000000005081
复制
发表时间：
2022
影响因子：
9
通讯作者：
Telem,DanaA
中科院分区：
文献类型：
--
作者：
Chhabra,KaranR;Scott,JohnW;Yang,Jie;Fan,Zhaohui;Dimick,JustinB;Telem,DanaA
方法我们使用IBM MarketScan商业索赔数据库，该数据库包含全美50个州约5000万雇主赞助健康保险计划成员（约占雇主赞助保险市场的三分之一）的支付数据。我们确定了年龄在18至64岁之间的患者，这些患者在2012-2018年期间在医院或门诊手术中心接受了10种常见手术中的1种，这些手术反映了不同的实践环境、专业和敏锐度水平。任何包含CPT代码之一的情节都被包括在内，即使付款或自付费用为零。手术发作时间为术前2天至术后30天。自付支出被定义为所有保险计划费用分摊的总和（对免赔额、共同保险或共付额的支付）。所有付款都调整为2018年的美元，并按第1和第99个百分位数计算。在Stata 16 （StataCorp）中进行分析。结果我们确定了1,885,471例手术发作。在96%的情况下，总自付费用超过0美元；在53%的剧集中，它超过了1000美元。
METHODSWe used the IBM MarketScan Commercial Claims Database, which contains payment data for approximately 50 million members of employer-sponsored health insurance plans (approximately one-third of the employer-sponsored insurance market) across all 50 states. We identified patients aged 18 to 64 years who underwent 1 of 10 common procedures chosen to reflect diverse practice settings, specialties, and acuity levels from 2012–2018 at hospitals or ambulatory surgery centers. Any episodes with one of the included CPT codes were included, even if payments or out-of-pocket-costs were zero. Surgical episodes spanned 2 days before surgery to 30 days after surgery. Out-of-pocket spending was defined as the sum of all insurance plan cost-sharing (payments toward deductibles, coinsurance, or copays). All payments are adjusted to 2018 dollars and winsorized to the 1 st and 99 th percentiles. Analyses were performed in Stata 16 (StataCorp).RESULTSWe identified 1,885,471 surgical episodes. In 96% of episodes, total out-of-pocket spending exceeded $0; in 53% of episodes, it exceeded $1000.