Steinberg E P, Javitt J C, Sharkey P D, Zuckerman A, Legro M W, Anderson G F, Bass E B, O'Day D
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
Arch Ophthalmol. 1993 Aug;111(8):1041-9. doi: 10.1001/archopht.1993.01090080037016.
Although more than 1 million cataract surgeries are performed annually in the United States, little is known about the frequency of use or cost of various services provided in connection with this procedure. To assess the frequency with which various ophthalmic, optometric, anesthesia, and medical services are provided in conjunction with cataract surgery and to estimate the cost to Medicare associated with those services, we analyzed 1985 through 1988 Medicare claims records of a nationally representative 5% sample of Medicare beneficiaries. The experience of 57,103 Medicare beneficiaries who underwent extracapsular cataract surgery in 1986 or 1987 that was not combined with another ophthalmologic procedure formed the basis of our analysis. Projections for current costs were performed using 1991 charges allowed by Medicare for physician services. We estimate that the median charge allowed by Medicare for a "typical" episode of cataract surgery in 1991 was approximately $2500. In addition to the $3.4 billion that Medicare spent in 1991 on such "typical" episodes, Medicare spent more than $39 million on miscellaneous "atypical" preoperative ophthalmologic tests, such as specular microscopy (14% of cases) and potential acuity testing (8% of cases), more than $7 million on postoperative ophthalmologic diagnostic tests, such as fluorescein angiography (3% of cases), and more than $18 million on perioperative medical services (most commonly electrocardiography and chest roentgenography). The major determinants of the cost to Medicare associated with cataract surgery are the rate of performance of cataract surgery and neodymium-YAG laser capsulotomy and the charges allowed for these procedures.(ABSTRACT TRUNCATED AT 250 WORDS)
尽管美国每年进行超过100万例白内障手术，但对于与此手术相关的各种服务的使用频率或成本却知之甚少。为了评估与白内障手术同时提供的各种眼科、验光、麻醉和医疗服务的频率，并估计医疗保险与这些服务相关的成本，我们分析了1985年至1988年医疗保险受益人的全国代表性5%样本的医疗保险理赔记录。1986年或1987年接受囊外白内障手术且未与其他眼科手术联合的57103名医疗保险受益人的经历构成了我们分析的基础。使用医疗保险1991年允许的医生服务收费对当前成本进行了预测。我们估计，1991年医疗保险对“典型”白内障手术的允许中位数收费约为2500美元。除了医疗保险在1991年为这类“典型”手术花费的34亿美元外，医疗保险还在杂项“非典型”术前眼科检查上花费了超过3900万美元，如镜面显微镜检查（14%的病例）和潜在视力测试（8%的病例），在术后眼科诊断检查上花费了超过700万美元，如荧光素血管造影（3%的病例），在围手术期医疗服务上花费了超过1800万美元（最常见的是心电图和胸部X线检查）。与白内障手术相关的医疗保险成本的主要决定因素是白内障手术和钕-YAG激光晶状体后囊切开术的执行率以及这些手术允许的收费。（摘要截短于250字）
