Memon Muzammil, Ginsberg Lydia, de Sa Darren, Nashed Andrew, Simunovic Nicole, Phillips Mark, Denkers Matthew, Ogilvie Rick, Peterson Devin, Ayeni Olufemi R
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Science, McMaster University, Hamilton, ON, Canada.
J Exp Orthop. 2017 Dec;4(1):1. doi: 10.1186/s40634-017-0076-6. Epub 2017 Jan 23.
Currently, there is a lack of knowledge regarding patient perceptions surrounding physician reimbursements, appropriate wait times, and out-of-pocket payment options for anterior cruciate ligament reconstruction (ACLR). Our objective was to determine the current state of these perceptions in an Ontario setting.
A survey was developed and pretested to address patient perceptions about physician reimbursements, appropriate wait times, and out-of-pocket payment options for ACLR using a focus group of experts and by reviewing prior surveys. The survey was administered to patients in a waiting room setting.
Two hundred and fifty completed surveys were obtained (79.9% response rate). Participants responded that an appropriate physician reimbursement for ACLR was $1000.00 and that the Ontario Health Insurance Plan (OHIP) reimbursed physicians $700.00 for ACLR. Seventy-four percent of participants responded that the OHIP reimbursement of $615.20 for the procedure was either lower or much lower than what they considered to be an appropriate reimbursement for ACLR. Over 90% of participants responded that an ACLR should occur within 90 days of injury. Thirty-five percent of participants were willing to pay $750.00 out-of-pocket to have an ACLR done sooner, while 16.4% of participants were willing to pay $2500.00 out-of-pocket to travel outside of Canada for expedited surgery.
This survey study demonstrates that patients' estimates of both appropriate and actual physician reimbursements were greater than the current reimbursement for ACLR. Further, the majority of individuals report that the surgical fee for ACLR is lower than what they consider to be an appropriate amount of compensation for the procedure. Additionally, nearly all respondents believe that a ruptured ACL should be reconstructed within 90 days of injury. Consequently, a number of patients are willing to pay out-of-pocket for expedited surgery either in Canada or abroad. However, patients' preferences for shorter wait times must be balanced with the known risk of arthrofibrosis associated with early ACLR.
目前，对于患者在前交叉韧带重建术（ACLR）中关于医生报销、合适的等待时间和自付费用选项的看法，我们了解不足。我们的目标是确定安大略省患者在这些方面看法的现状。
通过专家焦点小组并回顾之前的调查，开发并预先测试了一项关于患者对ACLR医生报销、合适等待时间和自付费用选项看法的调查。该调查在候诊室环境中对患者进行。
共获得250份完整调查问卷（回复率79.9%）。参与者表示ACLR合适的医生报销金额为1000.00加元，安大略省医疗保险计划（OHIP）为ACLR向医生报销700.00加元。74%的参与者表示OHIP对该手术615.20加元的报销金额低于或远低于他们认为ACLR合适的报销金额。超过90%的参与者表示ACLR应在受伤后90天内进行。35%的参与者愿意自付750.00加元以便更快进行ACLR，而16.4%的参与者愿意自付2500.00加元前往加拿大境外进行加急手术。
这项调查研究表明，患者对合适和实际医生报销金额的估计高于当前ACLR的报销金额。此外，大多数人报告ACLR的手术费用低于他们认为该手术合适的补偿金额。此外，几乎所有受访者都认为ACL断裂应在受伤后90天内重建。因此，许多患者愿意自付费用在加拿大或国外进行加急手术。然而，患者对缩短等待时间的偏好必须与早期ACLR已知的关节纤维化风险相平衡。
