Schehlein Emily M, Im Lily T, Robin Alan L, Onukwugha Eberechukwu, Saeedi Osamah J
*Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine‡Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD†Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI.
J Glaucoma. 2017 Apr;26(4):343-348. doi: 10.1097/IJG.0000000000000619.
Nonmedical out-of-pocket cost to both patients and their companions of office visits for routine glaucoma care has not been extensively studied in the United States. We evaluate potential key predictors of patient expenditures that are critical to assessing the cost-effectiveness of glaucoma health care delivery.
In total, 300 patients responded to the survey in 3 clinics in 2 clinical practice settings. Main outcome measures included both average visit and yearly expenditures.
Of the 300 patients, the majority were female (n=187, 62.3%) and African American (n=171, 57.0%). The median age was 66 years. The median [range; mean (SD)] expenditure per patient visit was $22.10 ($11.1, $42.9; $44.1 (72.8)). Patients with companions paid $38.77 more in average visit expenditure (β: 0.87, P<0.001). The average visit expenditure for retired patients was $17.37 less when compared with nonretired patients (β: -0.4, P=0.004). Patients living in a rural or suburban area paid $43.91 and $14.13 more per visit, respectively (β: 0.73, P=0.0004; β: 0.31, P=0.03), compared with patients living in an urban area. Patients with noncommercial insurance paid $24.01 less in average visit expenditure (β: -0.66, P=0.0008). The median yearly patient expenditure was $96.70 [$44.6, $222.7; $210.4 (333.9)]. Patients with companions paid $192.37 more in yearly expenditure (β: 0.9, P<0.001) than those without companions, whereas retired patients paid $80.83 less in yearly expenditure (β: -0.39, P=0.03) than nonretirees. Patients with noncommercial insurance paid $109.34 less in yearly expenditure (β: -0.63, P=0.01).
Although a small part of the total cost of glaucoma care, nonmedical out-of-pocket costs constitute a substantial noncovered medical expense to most patients in the United States. Patients who are employed, come with companions, live in nonurban areas, or are on Medicare have greater expenditures.
在美国，患者及其陪同人员因青光眼常规诊疗进行门诊的非医疗自付费用尚未得到广泛研究。我们评估了患者支出的潜在关键预测因素，这些因素对于评估青光眼医疗服务的成本效益至关重要。
共有300名患者在2种临床实践环境中的3家诊所对调查做出了回应。主要结局指标包括平均每次就诊费用和年度支出。
在这300名患者中，大多数为女性（n = 187，62.3%）且为非裔美国人（n = 171，57.0%）。年龄中位数为66岁。每位患者每次就诊的支出中位数[范围；均值（标准差）]为22.10美元（11.1美元，42.9美元；44.1美元（72.8美元））。有陪同人员的患者平均每次就诊支出多38.77美元（β：0.87，P < 0.001）。与未退休患者相比，退休患者平均每次就诊支出少17.37美元（β： - 0.4，P = 0.004）。与居住在城市地区的患者相比，居住在农村或郊区的患者每次就诊分别多支付43.91美元和14.13美元（β：0.73，P = 0.0004；β：0.31，P = 0.03）。拥有非商业保险的患者平均每次就诊支出少24.01美元（β： - 0.66，P = 0.0008）。患者年度支出中位数为96.70美元[44.6美元，222.7美元；210.4美元（333.9美元）]。有陪同人员的患者年度支出比没有陪同人员的患者多192.37美元（β：0.9，P < 0.001），而退休患者年度支出比未退休患者少80.83美元（β： - 0.39，P = 0.03）。拥有非商业保险的患者年度支出少109.34美元（β： - 0.63，P = 0.01）。
尽管非医疗自付费用在青光眼诊疗总成本中占比很小，但对美国大多数患者而言，它构成了一笔可观的未涵盖医疗费用。就业、有陪同人员、居住在非城市地区或参加医疗保险的患者支出更高。
