Increasing Out-of-Pocket Costs for Neurologic Care for Privately Insured Patients
- 23 December 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurology
- Vol. 96 (3), e322-e332
- https://doi.org/10.1212/wnl.0000000000011278
Abstract
Objective To measure the out-of-pocket (OOP) costs of evaluation and management (E/M) services and common diagnostic testing for neurology patients. Methods Using a large, privately insured health care claims database, we identified patients with a neurologic visit or diagnostic test from 2001 to 2016 and assessed inflation-adjusted OOP costs for E/M visits, neuroimaging, and neurophysiologic testing. For each diagnostic service each year, we estimated the proportion of patients with OOP costs, the mean OOP cost, and the proportion of the total service cost paid OOP. We modeled OOP cost as a function of patient and insurance factors. Results We identified 3,724,342 patients. The most frequent neurologic services were E/M visits (78.5%), EMG/nerve conduction studies (NCS) (7.7%), MRIs (5.3%), and EEGs (4.5%). Annually, 86.5%–95.2% of patients paid OOP costs for E/M visits and 23.1%–69.5% for diagnostic tests. For patients paying any OOP cost, the mean OOP cost increased over time, most substantially for EEG, MRI, and E/M. OOP costs varied considerably; for an MRI in 2016, the 50th percentile paid $103.10 and the 95th percentile paid $875.40. The proportion of total service cost paid OOP increased. High deductible health plan (HDHP) enrollment was associated with higher OOP costs for MRI, EMG/NCS, and EEG. Conclusion An increasing number of patients pay OOP for neurologic diagnostic services. These costs are rising and vary greatly across patients and tests. The cost sharing burden is particularly high for the growing population with HDHPs. In this setting, neurologic evaluation might result in financial hardship for patients.This publication has 21 references indexed in Scilit:
- Crowdsourcing healthcare costs: Opportunities and challenges for patient centered price transparencyHealthcare, 2016
- Promoting Cost Transparency to Reduce Financial Harm to PatientsThe AMA Journal of Ethic, 2015
- Medicare payments to the neurology workforce in 2012Neurology, 2015
- Impact of a High-deductible Health Plan on Outpatient Visits and Associated Diagnostic TestsMedical Care, 2014
- A Census of State Health Care Price Transparency WebsitesJAMA, 2013
- Choosing Wisely: Highest‐cost tests in outpatient neurologyAnnals of Neurology, 2013
- The RAND Health Insurance Experiment, Three Decades LaterJournal of Economic Perspectives, 2013
- High deductible health plans: does cost sharing stimulate increased consumer sophistication?Health Expectations, 2012
- Growth Of Consumer-Directed Health Plans To One-Half Of All Employer-Sponsored Insurance Could Save $57 Billion AnnuallyHealth Affairs, 2012
- The economics of moral hazard: commentPublished by Cambridge University Press (CUP) ,1982