Benjamin Chartock is a PhD student in the Health Care Management Department at the Wharton School and an associate fellow at the Leonard Davis Institute of Health Economics, both at the University of Pennsylvania, in Philadelphia.
Christopher Garmon (
Health Aff (Millwood). 2019 Mar;38(3):425-430. doi: 10.1377/hlthaff.2018.05399.
A surprise medical bill is a bill from an out-of-network provider that was not expected by the patient or that came from an out-of-network provider not chosen by the patient. We investigated consumers' hospital choices after receipt of surprise out-of-network medical bills in an elective situation, using a large national sample of medical claims for obstetric patients with two deliveries covered by employer-sponsored health insurance in 2007-14. We found that 11 percent of mothers experienced a surprise out-of-network bill with their first delivery, and this was associated with an increase of 13 percent in the odds of switching hospitals for the second delivery, compared to mothers who did not experience a surprise bill. Mothers who switched hospitals after a surprise out-of-network bill reduced their relative risk of receiving a second surprise medical bill by 56 percent, compared to mothers who did not switch after receiving their first surprise bill. These results highlight the harmful effects of surprise out-of-network bills, as patients are more likely to switch from their preferred hospital after receiving a surprise bill. Patients would benefit significantly from laws protecting them from the damaging financial consequences of surprise out-of-network bills, including those incurred in elective situations.
意料之外的医疗账单是指患者没有预料到的或来自非患者选择的网络外提供商的账单。我们在 2007 年至 2014 年期间，使用雇主赞助的健康保险覆盖的 2007 年至 2014 年期间的两次分娩的大量全国性医疗索赔的大型国家样本，调查了消费者在收到意外网络外医疗账单后的医院选择情况。我们发现，11%的母亲在第一次分娩时收到了意外的网络外账单，与没有收到意外账单的母亲相比，第二次分娩时选择换医院的几率增加了 13%。与第一次收到意外账单后没有换医院的母亲相比，收到意外网络外账单后换医院的母亲收到第二份意外医疗账单的相对风险降低了 56%。这些结果突出了意料之外的网络外账单的有害影响，因为患者在收到意外账单后更有可能从他们首选的医院转院。如果有法律保护患者免受意料之外的网络外账单（包括在选择性情况下产生的账单）的破坏性财务后果的影响，那么患者将受益匪浅。
