网络外空中救护费用:流行程度、规模和政策解决方案。

The Milbank Quarterly Pub Date : 2020-09-01 Epub Date: 2020-06-11 DOI:10.1111/1468-0009.12464
Erin C Fuse Brown, Erin Trish, Bich Ly, Mark Hall, Loren Adler
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引用次数: 10

摘要

网络外空中救护账单是一种意外医疗账单,它是由其他意外医疗账单背后的许多相同的市场失灵驱动的,包括患者在紧急情况下无法选择网络内提供者或避免网络外提供者潜在的余额账单。消费者面临的财务风险很高,因为超过四分之三的空中救护车不在网络范围内,价格很高,而且还在上涨。由于《航空公司放松管制法案》的联邦法律优先于州法律,面临网络外空中救护费用的消费者几乎没有法律保护。任何针对意外医疗账单的联邦政策都应该考虑意外空中救护账单,并应纳入实质性的消费者保护——而不仅仅是账单透明度——并纠正空中救护的市场扭曲。背景:网络外空中救护费用对消费者来说是一个日益严重的问题。由于大多数空中救护运输都在网络之外,价格也在上涨,病人面临着收到大笔意外账单的风险。本文估计了私人参保人员网外空中救护费用的普遍程度和规模,描述了限制意外空中救护费用的法律障碍,并提出了保护消费者免受网外空中救护费用影响的政策。方法:我们使用卫生保健成本研究所2014-2017年来自三家大型国家保险公司的数据来评估网络外空中救护索赔的份额以及潜在意外余额账单的患病率和规模,重点是旋翼运输。我们通过计算医疗服务提供者的账单费用和保险公司的网络外允许金额(包括患者的费用分摊)之间的差额,估计了网络外空中救护服务的潜在账单余额的大小。对于网络内的空中救护运输,我们计算了平均费用和允许的金额,包括绝对值和医疗保险为相同服务支付的费率的倍数。研究结果:我们发现只有不到四分之一的商业保险患者的空中救护运输是在网络内。五分之二的交通导致了潜在的账单余额,平均为19,851美元。在我们最近几年的数据中,独立(非医院)运营商的网络内运输费用平均为20,822美元,相当于相同服务的医疗保险费用的369%。结论:由于各州削减空中救护平衡账单的努力已经被航空放松管制法案所取代,因此需要联邦政府的解决方案。由于市场力量无法约束价格或供应,网络外空中救护费率应以医疗保险费率的数倍为基准,或者,空中救护服务可以通过竞争性招标和公用事业监管相结合的方式提供和融资。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Out-of-Network Air Ambulance Bills: Prevalence, Magnitude, and Policy Solutions.

Out-of-Network Air Ambulance Bills: Prevalence, Magnitude, and Policy Solutions.

Out-of-Network Air Ambulance Bills: Prevalence, Magnitude, and Policy Solutions.

Out-of-Network Air Ambulance Bills: Prevalence, Magnitude, and Policy Solutions.

Policy Points Out-of-network air ambulance bills are a type of surprise medical bill and are driven by many of the same market failures behind other surprise medical bills, including patients' inability to choose in-network providers in an emergency or to avoid potential balance billing by out-of-network providers. The financial risk to consumers is high because more than three-quarters of air ambulances are out-of-network and their prices are high and rising. Consumers facing out-of-network air ambulance bills have few legal protections owing to the Airline Deregulation Act's federal preemption of state laws. Any federal policies for surprise medical bills should also address surprise air ambulance bills and should incorporate substantive consumer protections-not just billing transparency-and correct the market distortions for air ambulances.

Context: Out-of-network air ambulance bills are a growing problem for consumers. Because most air ambulance transports are out-of-network and prices are rising, patients are at risk of receiving large unexpected bills. This article estimates the prevalence and magnitude of privately insured persons' out-of-network air ambulance bills, describes the legal barriers to curtailing surprise air ambulance bills, and proposes policies to protect consumers from out-of-network air ambulance bills.

Methods: We used the Health Care Cost Institute's 2014-2017 data from three large national insurers to evaluate the share of air ambulance claims that are out-of-network and the prevalence and magnitude of potential surprise balance bills, focusing on rotary-wing transports. We estimated the magnitude of potential balance bills for out-of-network air ambulance services by calculating the difference between the provider's billed charges and the insurer's out-of-network allowed amount, including the patient's cost-sharing. For in-network air ambulance transports, we calculated the average charges and allowed amounts, both in absolute magnitude and as a multiple of the rate that Medicare pays for the same service.

Findings: We found that less than one-quarter of air ambulance transports of commercially insured patients were in-network. Two-in-five transports resulted in a potential balance bill, averaging $19,851. In the latter years of our data, in-network rates for transports by independent (non-hospital-based) carriers averaged $20,822, or 369% of the Medicare rate for the same service.

Conclusions: Because the states' efforts to curtail air ambulance balance billing have been preempted by the Airline Deregulation Act, a federal solution is needed. Owing to the failure of market forces to discipline either prices or supply, out-of-network air ambulance rates should be benchmarked to a multiple of Medicare rates or, alternatively, air ambulance services could be delivered and financed through an approach that combines competitive bidding and public utility regulation.

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