Department of Economics, Duke University, Durham, North Carolina.
Department of Economics, Brigham Young University, Provo, Utah.
JAMA Netw Open. 2022 Oct 3;5(10):e2239131. doi: 10.1001/jamanetworkopen.2022.39131.
Despite a widespread belief that private insurers spend large amounts on health care for enrollees receiving dialysis, data limitations over the past decade have precluded a comprehensive analysis of the topic.
To examine the amount and types of increases in health care spending for privately insured patients associated with initiating dialysis care.
DESIGN, SETTING, AND PARTICIPANTS: A cohort study covering calendar years 2012 to 2019 included patients with kidney failure who had employer-sponsored insurance for 12 months following dialysis initiation. Data analysis was performed from August 27, 2021, to August 18, 2022. The data cover the entirety of the US and were obtained from the Health Care Cost Institute. The data include all medical claims for enrollees in employer-sponsored health insurance plans offered by multiple major health care insurers within the US. Participants included patients younger than 65 years who were continuously enrolled in these plans in the 12 months before and after their first claim for dialysis care. Patients also had to have nonmissing documented key characteristics, such as sex, race and ethnicity, and health characteristics.
A claim for dialysis care.
Out-of-pocket, inpatient, outpatient, physician services, prescription medication, and total health care spending. The hypothesis tested was formulated before data collection.
The sample included 309 800 enrollee-months, which was a balanced panel of 25 months for 12 392 enrollees. At baseline, 7534 patients (61%) were male, 5415 (44%) were aged 55 to 64 years, and patients had been enrolled with their insurer for a mean of 30 months (95% CI, 29.9-30.1 months). In the 12 months before initiating dialysis care, total monthly health care spending was $5025 per patient per month (95% CI, $4945-$5106). Dialysis care initiation was associated with an increase in total monthly spending of $14 685 (95% CI, $14 413-$14 957). This increase occurred across all spending categories (dialysis, nondialysis outpatient, inpatient, physician services, and prescription drugs). Monthly patient out-of-pocket spending increased by $170 (95% CI, $162-$178). These spending increases occurred abruptly, beginning about 2 months before dialysis initiation, and remained increased for the subsequent 12 months.
In this cohort study, evidence that private insurers experience significant, sustained increases in spending when patients initiated dialysis was noted. The findings suggest that proposed policies aimed at limiting the amount dialysis facilities charge private insurers and the enrollees has the potential to reduce health care spending in this high-cost population.
尽管普遍认为私人保险公司在为接受透析治疗的参保人提供医疗保健方面花费了大量资金，但过去十年的数据限制使得人们无法全面分析这一问题。
研究与开始透析治疗相关的私人保险参保人医疗保健支出增加的数量和类型。
设计、地点和参与者：一项涵盖 2012 年至 2019 年的队列研究纳入了在开始透析后有雇主赞助保险的肾功能衰竭患者。数据分析于 2021 年 8 月 27 日至 2022 年 8 月 18 日进行。该数据涵盖了整个美国，是从美国多家主要医疗保险公司提供的雇主赞助健康保险计划的参保人那里获得的。参与者包括年龄在 65 岁以下、在首次申请透析治疗前的 12 个月内连续参加这些计划的患者。患者还必须具有非缺失的有记录的关键特征，如性别、种族和民族以及健康特征。
透析治疗的索赔。
自付、住院、门诊、医生服务、处方药物和总医疗保健支出。测试的假设是在数据收集之前制定的。
样本包括 309800 个参保人-月，这是 12392 名参保人的 25 个月平衡面板。基线时，7534 名患者（61%）为男性，5415 名（44%）为 55 至 64 岁，患者已与保险公司签约 30 个月（95%CI，29.9-30.1 个月）。在开始透析治疗前的 12 个月中，每位患者每月的总医疗保健支出为 5025 美元（95%CI，4945-5106 美元）。开始透析治疗与每月总支出增加 14685 美元（95%CI，14413-14957 美元）相关。这种增加发生在所有支出类别（透析、非透析门诊、住院、医生服务和处方药）。每月患者自付支出增加 170 美元（95%CI，162-178 美元）。这些支出增加是突然发生的，大约在开始透析前 2 个月开始，并在随后的 12 个月内持续增加。
在这项队列研究中，有证据表明，当患者开始透析时，私人保险公司的支出会出现显著且持续的增加。研究结果表明，旨在限制透析机构向私人保险公司和参保人收取的费用的拟议政策有可能降低这一高成本人群的医疗保健支出。
