From the Health Services Research Program, Department of Neurology (C.E.H., E.L.R., J.F.B., K.A.K., L.E.S., B.C.C.), and School of Public Health (M.B.), University of Michigan; Veterans Affairs Healthcare System (J.F.B., B.C.C.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA.
Neurology. 2021 Jan 19;96(3):e322-e332. doi: 10.1212/WNL.0000000000011278. Epub 2020 Dec 23.
To measure the out-of-pocket (OOP) costs of evaluation and management (E/M) services and common diagnostic testing for neurology patients.
Using a large, privately insured health care claims database, we identified patients with a neurologic visit or diagnostic test from 2001 to 2016 and assessed inflation-adjusted OOP costs for E/M visits, neuroimaging, and neurophysiologic testing. For each diagnostic service each year, we estimated the proportion of patients with OOP costs, the mean OOP cost, and the proportion of the total service cost paid OOP. We modeled OOP cost as a function of patient and insurance factors.
We identified 3,724,342 patients. The most frequent neurologic services were E/M visits (78.5%), EMG/nerve conduction studies (NCS) (7.7%), MRIs (5.3%), and EEGs (4.5%). Annually, 86.5%-95.2% of patients paid OOP costs for E/M visits and 23.1%-69.5% for diagnostic tests. For patients paying any OOP cost, the mean OOP cost increased over time, most substantially for EEG, MRI, and E/M. OOP costs varied considerably; for an MRI in 2016, the 50th percentile paid $103.10 and the 95th percentile paid $875.40. The proportion of total service cost paid OOP increased. High deductible health plan (HDHP) enrollment was associated with higher OOP costs for MRI, EMG/NCS, and EEG.
An increasing number of patients pay OOP for neurologic diagnostic services. These costs are rising and vary greatly across patients and tests. The cost sharing burden is particularly high for the growing population with HDHPs. In this setting, neurologic evaluation might result in financial hardship for patients.
衡量神经科患者评估和管理（E/M）服务以及常见诊断性检查的自付费用。
我们使用一个大型私人医疗保险健康护理索赔数据库，确定了 2001 年至 2016 年间有神经科就诊或诊断性检查的患者，并评估了 E/M 就诊、神经影像学和神经生理学检查的通胀调整后自付费用。对于每一种诊断服务，我们估计了自付费用患者的比例、平均自付费用以及总服务费用中自付费用的比例。我们将自付费用建模为患者和保险因素的函数。
我们确定了 3724342 名患者。最常见的神经科服务是 E/M 就诊（78.5%）、肌电图/神经传导研究（NCS）（7.7%）、磁共振成像（MRI）（5.3%）和脑电图（EEG）（4.5%）。每年，86.5%-95.2%的 E/M 就诊患者和 23.1%-69.5%的诊断性检查患者需要支付自付费用。对于支付任何自付费用的患者，自付费用的平均值随时间增加，脑电图、MRI 和 E/M 的增加幅度最大。自付费用差异很大；在 2016 年，MRI 的第 50 百分位数支付 103.10 美元，第 95 百分位数支付 875.40 美元。自付费用占总服务费用的比例增加。高免赔额健康计划（HDHP）的参与与 MRI、EMG/NCS 和 EEG 的自付费用增加有关。
越来越多的患者需要支付神经科诊断性服务的自付费用。这些费用正在上升，并且在患者和检查之间差异很大。对于拥有越来越多 HDHP 的人群来说，成本分担负担尤其沉重。在这种情况下，神经科评估可能会给患者带来经济困难。
