Sun Eric C, Mello Michelle M, Moshfegh Jasmin, Baker Laurence C
Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, California.
Department of Health Research and Policy, Stanford University School of Medicine, Stanford University, Stanford, California.
JAMA Intern Med. 2019 Nov 1;179(11):1543-1550. doi: 10.1001/jamainternmed.2019.3451.
Although surprise medical bills are receiving considerable attention from lawmakers and the news media, to date there has been little systematic study of the incidence and financial consequences of out-of-network billing.
To examine out-of-network billing among privately insured patients with an inpatient admission or emergency department (ED) visit at in-network hospitals.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis using data from the Clinformatics Data Mart database (Optum), which includes health insurance claims for individuals from all 50 US states receiving private health insurance from a large commercial insurer was conducted of all inpatient admissions (n = 5 457 981) and ED visits (n = 13 579 006) at in-network hospitals between January 1, 2010, and December 31, 2016. Data were collected and analyzed in March 2019.
Receipt of a bill for care from at least 1 out-of-network physician or medical transport service associated with patient admission or ED visit.
The incidence of out-of-network billing and the potential amount of patients' financial liability associated with out-of-network bills from the admission or visit.
Of 5 457 981 inpatient admissions and 13 579 006 ED admissions between 2010 and 2016, the percentage of ED visits with an out-of-network bill increased from 32.3% to 42.8% (P < .001) during the study period, and the mean (SD) potential financial responsibility for these bills increased from $220 ($420) to $628 ($865) (P < .001; all dollar values in 2018 US$). Similarly, the percentage of inpatient admissions with an out-of-network bill increased from 26.3% to 42.0% (P < .001), and the mean (SD) potential financial responsibility increased from $804 ($2456) to $2040 ($4967) (P < .001).
Out-of-network billing appears to have become common for privately insured patients even when they seek treatment at in-network hospitals. The mean amounts billed appear to be sufficiently large that they may create financial strain for a substantial proportion of patients.
尽管意外医疗账单正受到立法者和新闻媒体的广泛关注，但迄今为止，对于网络外计费的发生率和财务后果，几乎没有系统的研究。
研究在网络内医院住院或就诊的私人保险患者的网络外计费情况。
设计、设置和参与者：使用Clinformatics数据集市数据库（Optum）的数据进行回顾性分析，该数据库包含来自美国所有50个州、接受一家大型商业保险公司私人医疗保险的个人的健康保险索赔数据。对2010年1月1日至2016年12月31日期间网络内医院的所有住院病例（n = 5457981）和急诊就诊病例（n = 13579006）进行了分析。数据于2019年3月收集和分析。
收到至少一张与患者住院或急诊就诊相关的网络外医生或医疗运输服务的账单。
网络外计费的发生率以及与住院或就诊的网络外账单相关的患者潜在财务责任金额。
在2010年至2016年的5457981例住院病例和13579006例急诊病例中，研究期间有网络外账单的急诊就诊比例从32.3%增至42.8%（P <.001），这些账单的平均（标准差）潜在财务责任从220美元（420美元）增至628美元（865美元）（P <.001；所有美元价值均为2018年美元）。同样，有网络外账单的住院病例比例从26.3%增至42.0%（P <.001），平均（标准差）潜在财务责任从804美元（2456美元）增至2040美元（4967美元）（P <.001）。
即使私人保险患者在网络内医院寻求治疗，网络外计费似乎也已变得普遍。所开账单的平均金额似乎足够大，可能会给相当一部分患者造成财务压力。
