未手术治疗的小儿桡骨远端骨折的经济负担：私人保险与公共保险患者的医疗债务。

The Financial Burden of Nonoperatively Treated Pediatric Distal Radius Fractures: Medical Debt in Privately Versus Publicly Insured Patients.

机构信息

Department of Orthopaedics, The Johns Hopkins University, Baltimore, MD.

出版信息

J Pediatr Orthop. 2022 Feb 1;42(2):65-69. doi: 10.1097/BPO.0000000000002021.

DOI:10.1097/BPO.0000000000002021

PMID:34995256

Abstract

BACKGROUND

Patients with public health insurance have greater difficulty obtaining orthopaedic care than their privately insured counterparts because of lower reimbursements. However, the relationship between insurance status and financial burden for patients and treating institutions is unknown. We compared patient medical debt and uncompensated hospital costs by insurance type for pediatric patients who received nonoperative treatment for distal radius fractures (DRFs).

METHODS

We reviewed medical records of 100 pediatric patients (above 18 y) treated nonoperatively at our US academic hospital for DRFs from 2016 to 2020. Patients were grouped according to insurance type at the time of treatment: preferred-provider organization (PPO), n=30; health maintenance organization (HMO), n=29; Medicaid, n=28; and uninsured, n=13. These groups were matched by number of encounters, total original charge, and total number of charges. The primary outcomes were patient medical debt and uncompensated costs to the hospital, comprising unpaid balance, uncollectible debt, and self-adjustments offered by the hospital. χ2 tests and analysis of variance were used to compare financial outcomes among subgroups (alpha=0.05).

RESULTS

Patient medical debt (ie, uncollectible debt) was generated by 20% of PPO, 7.7% of uninsured, and 6.9% of HMO patients (P=0.06). Medicaid patients generated no patient medical debt, whereas PPO patients generated a mean (±SD) of $15±$39 and HMO patients generated $26±$130, which was not significantly different than that of uninsured patients ($25±$89) (P<0.0001). Uncompensated costs were generated by 54% of uninsured, 20% of PPO, 6.9% of HMO, and 0% of Medicaid patients (P<0.0001). Uncompensated costs were the same as uncollectible debt for privately insured and Medicaid patients, whereas uninsured patients generated an additional $550±$600 from self-adjustments (P<0.0001).

CONCLUSION

Unlike the Medicaid group, the privately insured and uninsured groups incurred patient medical debt and uncompensated costs after nonoperative DRF treatment. Thus, orthopaedic providers should be cost conscious with privately insured patients, while publicly insured patients may provide more consistent-albeit lower-reimbursement for the hospital.

LEVEL OF EVIDENCE

Level III.

摘要

背景

由于报销金额较低，拥有公共医疗保险的患者在获得骨科治疗方面比私人保险患者更为困难。然而，患者和治疗机构的保险状况与经济负担之间的关系尚不清楚。我们比较了接受非手术治疗的儿童患者的医疗保险类型与患者医疗债务和未补偿医院费用之间的关系，这些患者的疾病为桡骨远端骨折（DRF）。

方法

我们回顾了 2016 年至 2020 年期间在我们美国学术医院接受非手术治疗 DRF 的 100 名儿科患者的病历。根据治疗时的保险类型将患者分为以下几组：首选提供者组织（PPO），30 例；健康维护组织（HMO），29 例；医疗补助（Medicaid），28 例；和无保险，13 例。通过就诊次数、原始总费用和总费用数对这些组进行匹配。主要结果是患者医疗债务和医院未补偿费用，包括未付余额、无法收回的债务和医院提供的自我调整。使用卡方检验和方差分析比较亚组之间的财务结果（α=0.05）。

结果

20%的 PPO、7.7%的无保险和 6.9%的 HMO 患者产生了患者医疗债务（即无法收回的债务）（P=0.06）。医疗补助患者没有产生任何患者医疗债务，而 PPO 患者产生了平均（±SD）15±39 美元，HMO 患者产生了 26±130 美元，与无保险患者（25±89 美元）没有显著差异（P<0.0001）。54%的无保险患者、20%的 PPO 患者、6.9%的 HMO 患者和 0%的医疗补助患者产生了未补偿费用（P<0.0001）。未补偿费用与无法收回的债务对私人保险和医疗补助患者相同，而无保险患者通过自我调整产生了额外的 550±600 美元（P<0.0001）。