Pellino Teresa A, Gordon Debra B, Dahl June L
University of Wisconsin Hospitals and Clinies, Madison 53792, USA.
WMJ. 2006 Jun;105(4):27-31, 50.
Reimbursement obstacles, such as inadequate insurance coverage, have been identified as barriers to adequate pain management. The purpose of this study was to determine Wisconsin insurers' and managed care organizations' (MCOs) policies and practices regarding pain treatment and MCO medical directors' perceptions of barriers to providing effective pain management for their enrollees.
A descriptive qualitative design was used with semi-structured interviews of 6 administrative executives of commercial health management organizations' products from the major insurers in Wisconsin.
None of the companies interviewed had systematically tracked data or had processes in place to allow them to track, analyze or trend data specific to pain management. Chronic noncancer pain is recognized more frequently as an insurance coverage issue because of high drug costs. Pharmacologic and interventional therapies are routinely covered compared with nonpharmacologic therapies with some prior authorizations, especially for newer medications. A uniformly identified barrier was lack of a comprehensive, interdisciplinary, integrated approach to pain management and inadequate data on the cost effectiveness of various approaches.
Opportunities exist to educate and improve communication between health care professionals, purchasers of health care (employers), primary care providers and pain specialists. The economics of pain management needs to be made more "visible" through the development of coding and tracking mechanisms.
报销障碍，如保险覆盖不足，已被确定为充分疼痛管理的障碍。本研究的目的是确定威斯康星州保险公司和管理式医疗组织（MCO）关于疼痛治疗的政策和做法，以及MCO医疗主任对为其参保人提供有效疼痛管理的障碍的看法。
采用描述性定性设计，对威斯康星州主要保险公司的商业健康管理组织产品的6名行政高管进行半结构化访谈。
接受采访的公司均未系统地跟踪数据，也没有建立相关流程以跟踪、分析或统计疼痛管理方面的特定数据。由于药物成本高昂，慢性非癌性疼痛更常被视为保险覆盖问题。与非药物治疗相比，药物和介入治疗通常可报销，但有些需要事先批准，特别是对于较新的药物。一个普遍存在的障碍是缺乏全面、跨学科、综合的疼痛管理方法，以及关于各种方法成本效益的不充分数据。
存在教育和改善医疗保健专业人员、医疗保健购买者（雇主）、初级保健提供者和疼痛专家之间沟通的机会。需要通过开发编码和跟踪机制，使疼痛管理的经济学情况更“清晰可见”。
