Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
HPB (Oxford). 2019 Jun;21(6):765-772. doi: 10.1016/j.hpb.2018.10.011. Epub 2018 Nov 27.
The burden of health care spending in the United States is a major concern, as health care costs have exponentially increased during the last three decades. The objective of the current study was to investigate the degree of cost-concentration among Medicare patients undergoing liver and pancreatic surgery.
Medicare claims data from 2013 to 2015 were used to identify patients undergoing elective liver and pancreatic resections. Patients were divided into four groups: 1) non-complex pancreatic procedures; 2) complex pancreatic procedures; 3) non-complex liver procedures; and 4) complex liver procedures. Unadjusted price-standardized Medicare payments were calculated and payments were divided into quintiles. Patient-level factors associated with payments were analyzed by multivariable linear regression.
A total of 17,125 patients were included in the study. Patients in the top quintile of spending accounted for over 40% of payments for all liver and pancreatic procedures. Patients with comorbidity scores ≥5, male sex, open surgical approach and a diagnosis of congestive heart failure were associated with higher costs.
Patients undergoing liver and pancreatic resections on the top 20% of payments were responsible for a disproportionate share of Medicare payments - over 40% of total expenditures. Overall hospital surgical volume was lower among the highest quintile of payments.
美国医疗保健支出负担是一个主要关注点，因为在过去三十年中，医疗保健成本呈指数级增长。本研究的目的是调查接受肝胰手术的 Medicare 患者的成本集中程度。
使用 2013 年至 2015 年的 Medicare 索赔数据来确定接受择期肝胰切除术的患者。患者分为四组：1）非复杂胰部手术；2）复杂胰部手术；3）非复杂肝部手术；4）复杂肝部手术。计算未经调整的价格标准化 Medicare 支付额，并将支付额分为五分位数。通过多变量线性回归分析与支付额相关的患者水平因素。
共有 17125 名患者纳入研究。在所有肝胰手术中，支出最高五分位数的患者支付的费用超过 40%。合并症评分≥5、男性、开放式手术方法和充血性心力衰竭诊断与较高的成本相关。
在支出前 20%的患者中，接受肝胰切除术的患者承担了 Medicare 支出的不成比例的份额-占总支出的 40%以上。在支出最高的五分位数中，整体医院手术量较低。
