Department of Surgery, University of Michigan, Ann Arbor.
Central Michigan University College of Medicine, Saginaw.
JAMA Surg. 2023 Sep 1;158(9):920-926. doi: 10.1001/jamasurg.2023.2017.
Lymphedema is a debilitating condition that affects approximately 1 in 1000 individuals in the United States. Complete decongestive therapy is currently the standard of care, and innovative surgical techniques have demonstrated potential to further improve outcomes. Despite the growing armamentarium of treatment options, a large proportion of patients with lymphedema continue to struggle because of limited access to care.
To define the current state of insurance coverage for lymphedema treatments in the United States.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional analysis of insurance reimbursement for lymphedema treatments in 2022 was designed. The top 3 insurance companies per state based on market share and enrollment data maintained by the Kaiser Family Foundation were included. Established medical policies were gathered from insurance company websites and phone interviews, and descriptive statistics were performed.
Treatments of interest included nonprogrammable pneumatic compression, programmable pneumatic compression, surgical debulking, and physiologic procedures. Primary outcomes included level of coverage and criteria for coverage.
This study included 67 health insurance companies representing 88.7% of the US market share. Most insurance companies offered coverage for nonprogrammable (n = 55, 82.1%) and programmable (n = 53, 79.1%) pneumatic compression. However, few insurance companies offered coverage for debulking (n = 13, 19.4%) or physiologic (n = 5, 7.5%) procedures. Geographically, the lowest rates of coverage were seen in the West, Southwest, and Southeast.
This study suggests that in the United States, less than 12% of individuals with health insurance, and even fewer patients without health insurance, have access to pneumatic compression and surgical treatments for lymphedema. The stark inadequacy of insurance coverage must be addressed through research and lobbying efforts to mitigate health disparities and promote health equity among patients with lymphedema.
在美国，大约每 1000 人中就有 1 人患有淋巴水肿，这种疾病使患者身体虚弱。目前，完整的减压治疗是标准的治疗方法，创新的手术技术已被证明有可能进一步改善治疗效果。尽管治疗选择的手段越来越多，但由于获得治疗的机会有限，大多数淋巴水肿患者仍在苦苦挣扎。
定义美国淋巴水肿治疗的保险覆盖现状。
设计、环境和参与者：本研究设计了对 2022 年淋巴水肿治疗保险报销的横断面分析。根据凯撒家庭基金会（Kaiser Family Foundation）维护的市场份额和参保人数数据，选择每个州的前 3 家保险公司。从保险公司网站和电话访谈中收集既定的医疗政策，并进行描述性统计。
感兴趣的治疗方法包括非程控气动加压、程控气动加压、手术去脂以及生理治疗。主要结果包括覆盖水平和覆盖标准。
本研究共纳入 67 家医疗保险公司，代表美国 88.7%的市场份额。大多数保险公司都提供非程控（n=55，82.1%）和程控（n=53，79.1%）气动加压治疗的保险。然而，很少有保险公司提供去脂（n=13，19.4%）或生理（n=5，7.5%）治疗的保险。从地理位置上看，西部地区、西南部地区和东南部地区的保险覆盖率最低。
本研究表明，在美国，只有不到 12%的有医疗保险的个人，甚至更少的没有医疗保险的个人能够获得淋巴水肿的气动加压和手术治疗。保险覆盖的严重不足必须通过研究和游说努力来解决，以减轻淋巴水肿患者的健康差距，促进健康公平。
