五分之一的病人在手術(shù)后會(huì)收到意外的醫(yī)藥費(fèi)賬單

五分之一的病人在手術(shù)后會(huì)收到意外的醫(yī)藥費(fèi)賬單

Two bills up for debate and revision in the House this week aim to stop surprise medical billing — when patients are billed for services their insurance won't cover. New research reveals just how common surprise billing is after an elective surgery, like a knee replacement or hysterectomy.

本周將在眾議院進(jìn)行辯論和修改的兩項(xiàng)法案旨在停止突如其來的醫(yī)療賬單-當(dāng)患者被收取他們的保險(xiǎn)不覆蓋的服務(wù)賬單時(shí)。一項(xiàng)新的研究表明，在膝關(guān)節(jié)置換或子宮切除術(shù)等選擇性手術(shù)后，突如其來的賬單很普遍。

Tracking data from almost 350.000 patients with a large commercial insurer, the researchers found that more than 20% were hit with an unpaid balance, according to a study released Tuesday in JAMA. The average bill was over $2.000.

據(jù)《美國(guó)醫(yī)學(xué)會(huì)雜志》周二發(fā)表的一項(xiàng)研究，研究人員追蹤了一家大型商業(yè)保險(xiǎn)公司近35萬(wàn)名患者的數(shù)據(jù)，發(fā)現(xiàn)有20%以上的患者有未付余額。平均賬單超過2000美元。

The researchers didn't have the actual bills received by patients, so they calculated what health care providers could bill based on claims data:

研究人員沒有病人實(shí)際收到的賬單，所以他們根據(jù)索賠數(shù)據(jù)計(jì)算了醫(yī)療服務(wù)提供者可以收取的費(fèi)用:

"For a large percentage of the public, getting one of these bills is really going to be financially devastating," says Zack Cooper, an associate professor of public health and economics at Yale University's School of Medicine, who wasn't involved with the study. A Federal Reserve report found that nearly 40% of adults in the United States in 2018 would have trouble paying an unexpected $400 bill.

耶魯大學(xué)醫(yī)學(xué)院公共衛(wèi)生與經(jīng)濟(jì)學(xué)副教授扎克·庫(kù)珀沒有參與這項(xiàng)研究，他說：“對(duì)于很大一部分公眾來說，拿到其中一張賬單真的會(huì)在經(jīng)濟(jì)上造成毀滅性的后果。”美聯(lián)儲(chǔ)的一份報(bào)告發(fā)現(xiàn)，2018年美國(guó)近40%的成年人難以支付一筆意外的400美元賬單。

Surprise bills are common after emergency care or nonsurgical hospital stays, when patients may not be able to choose health care providers covered by their insurance. (Twenty percent of inpatient admissions from the emergency department likely led to a surprise bill, a Health Affairs study found.) For elective surgeries, patients often have time to select in-network providers, but it didn't appear to make a difference.

在緊急護(hù)理或非手術(shù)住院后，當(dāng)患者可能無(wú)法選擇保險(xiǎn)覆蓋的醫(yī)療保健提供者時(shí)，意外賬單很常見。(衛(wèi)生事務(wù)的一項(xiàng)研究發(fā)現(xiàn)，急診科20%的住院人數(shù)可能會(huì)收到一份出人意料的賬單。)對(duì)于選擇性手術(shù)，患者通常有時(shí)間選擇(保險(xiǎn))網(wǎng)絡(luò)覆蓋內(nèi)的提供者，但似乎沒有什么不同。

The study found that most of the surprise bills come from either anesthesiologists or surgical assistants — who are typically not chosen by patients.

研究發(fā)現(xiàn)，大多數(shù)意外賬單來自麻醉師或手術(shù)助理，而這些人通常不是病人選擇的。

Chhabra doesn't always get to see his patients after they've received bills. But his friends and colleagues have dealt with surprise bills themselves. "The surgical community had to do something about this and find out exactly how often this is going on," he says.

查布拉并不總是在病人收到帳單后才去看他們。但他的朋友和同事們自己也處理過意外的賬單。他說:“外科界必須對(duì)此采取行動(dòng)，查明這種情況到底有多頻繁。”

The study arrives during a time when Congress is debating how to address this problem. The two bills under discussion take differing approaches to resolving these outstanding payments when they're no longer placed on the shoulders of patients.

這項(xiàng)研究是在國(guó)會(huì)討論如何解決這個(gè)問題的時(shí)候進(jìn)行的。正在討論的兩項(xiàng)法案采取了不同的方法來解決這些未償款項(xiàng)，因?yàn)樗鼈儾辉儆刹∪藖沓袚?dān)。

Either of the two bills would be an improvement over the status quo, Cooper says. But it's unclear what measures will really make it into law.

庫(kù)珀說，這兩項(xiàng)法案中的任何一項(xiàng)都將是對(duì)現(xiàn)狀的改善。但目前還不清楚哪些措施會(huì)真正成為法律。

"The devil's obviously in the details," Chhabra says.

“魔鬼顯然存在于細(xì)節(jié)之中，”查布拉說。

Surprise billing was a focus in Congress last year as well, but legislation never made it through. There's now a lot of opportunity for Congress to take action, says Jean Fuglesten Biniek, a senior researcher at the Health Care Cost Institute, a nonprofit research center focused on health care.

意外的賬單也是去年國(guó)會(huì)關(guān)注的焦點(diǎn)，但立法從未通過。醫(yī)療保健成本研究所高級(jí)研究員比內(nèi)克說，現(xiàn)在國(guó)會(huì)有很多機(jī)會(huì)采取行動(dòng)。該研究所是一個(gè)專注于醫(yī)療保健的非營(yíng)利性研究中心。