Vivian Ho (
Sasathorn Tapaneeyakul, Rice University.
Health Aff (Millwood). 2023 Aug;42(8):1119-1127. doi: 10.1377/hlthaff.2022.01287.
Recent studies document a substantial increase in emergency department (ED) spending in the past decade, even though the number of ED visits per capita has remained relatively stable. Price increases and upcoding are sometimes cited as possible explanations, but their relative impacts are not known. We analyzed Blue Cross Blue Shield claims for patients of all ages who received care in EDs in five states in 2012 and 2019. We used estimates from spending regressions and regressions explaining coding intensity to decompose changes in spending between 2012 and 2019 into components attributable to price increases, changes in patient characteristics or treatment intensity, and upcoding. Prices accounted for at least half of the increase in ED spending per visit for four of the five states we examined. Increases in spending attributable to upcoding were notable but generally not as large. Future research should explore the associations between local market conditions, such as consolidation and ownership type, and both price increases and upcoding.
最近的研究表明，尽管人均急诊就诊次数相对稳定，但在过去十年中，急诊部门的支出大幅增加。价格上涨和编码升级有时被认为是可能的解释，但它们的相对影响尚不清楚。我们分析了 2012 年和 2019 年五个州接受急诊治疗的所有年龄段患者的蓝十字蓝盾索赔。我们使用支出回归和解释编码强度的回归来将 2012 年至 2019 年期间的支出变化分解为归因于价格上涨、患者特征或治疗强度变化以及编码升级的组成部分。我们研究的五个州中的四个州，每次急诊就诊的支出增加至少有一半是由于价格上涨所致。由于编码升级而导致的支出增加虽然引人注目，但通常没有那么大。未来的研究应探讨当地市场条件（如合并和所有权类型）与价格上涨和编码升级之间的关联。
