Juarez Deborah Taira, Guimaraes Alexander, Seto Brendan, Davis James W
Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (DTJ, AG).
Hawaii J Med Public Health. 2015 May;74(5):169-73.
When Medicare publically released data on payments made to specific physicians in April of 2014, it quickly became apparent that a large portion of 2012 Medicare reimbursements went to ophthalmologists. Part of the reason for this unusually high level of reimbursement was thought to be the cost of injectable drugs such as ranibizumab (brand name Lucentis). This study was designed to compare Hawai'i ophthalmologists' Medicare reimbursements with those of other states. In 2012, Medicare payment to ophthalmologists in Hawai'i was $18.2 million. Hawai'i ranked third in the nation in terms of percentage of total reimbursement going to ophthalmologists at 11.1% and 34th (8.2%) in percentage of ophthalmologist reimbursements going to injectable biological products. Hence, the high percentage of reimbursement going to ophthalmologists in Hawai'i is unlikely due to high use of injectable medications. Further research, based on a more detailed analysis of clinical data, is needed to determine how to slow the growth of health care costs while promoting high-value, effective care, not only for ophthalmic services but in other high-cost areas as well.
2014年4月医疗保险公开公布了向特定医生支付费用的数据，很快就发现2012年医疗保险的很大一部分报销费用流向了眼科医生。报销水平异常高的部分原因被认为是诸如雷珠单抗（商品名：Lucentis）等注射药物的成本。本研究旨在比较夏威夷眼科医生的医疗保险报销情况与其他州的情况。2012年，医疗保险向夏威夷眼科医生支付的费用为1820万美元。夏威夷在眼科医生获得的报销总额占比方面位居全国第三，为11.1%，在眼科医生报销费用中注射用生物制品所占百分比方面排名第34位（8.2%）。因此，夏威夷眼科医生获得的报销比例高不太可能是由于注射药物的高使用量。需要基于对临床数据更详细的分析进行进一步研究，以确定如何在促进高价值、有效护理的同时减缓医疗保健成本的增长，不仅针对眼科服务，也针对其他高成本领域。
