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Direct spending on institutional services was less than 5% for COVID-19 hospital patients in the United States, according to data from a cross-sectional study of more than 7 million patients.
To ease the financial burden of hospitalization for COVID-19, many insurance companies have moved away from cost sharing during the height of the pandemic in all or part of 2020, write Kao-Ping Chua, MD, of the University of Michigan, Ann Arbor, and colleagues.
However, some patients may have been billed for categories of care not covered by waivers, the researchers said. The bill categories include facility services, “such as inpatient accommodation and pharmacy services,” and the services of clinicians and ancillary service providers, known as “professional and attendant services,” they note. .
“Protecting patients from the costs of COVID-19-related hospitalizations in particular can be particularly important given the number of hospitalizations that can occur and given that the threat of cost-sharing could deter patients with severe symptoms of COVID- 19 to seek treatment ”, but the amounts for which COVID-19 patients were billed in 2020 in different categories of services have not been evaluated, the researchers point out.
In the study published in JAMA network open, researchers examined data from March 2020 to September 2020 from the IQVIA PharMetrics Plus for Academics database, a national claims database comprising 7.7 million patients with private insurance and 1.0 million patients with Medicare Advantage. The primary outcome measure was total out-of-pocket expenditure, defined as the sum of expenditures for settlement services billed by hospitals and professional and ancillary services billed by clinicians and other providers.
The final analysis included 4,075 hospitalizations; 1377 of these were privately insured patients and 2,968 were Medicare Advantage patients. The mean age of the patients was 66.8 years and 51.3% were men.
Overall, 981 (71.2%) of privately insured patients and 1324 (49.1%) of Medicare Advantage patients reported direct expenditures for facility services, professional and attendant services, or two for COVID-19-related hospitalizations during the study period. The average out-of-pocket total amounts were $ 788 for privately insured patients and $ 277 for Medicare Advantage patients.
The average length of hospital stay for privately insured patients was 7.3 days, and 640 (46.5%) of hospitalizations included use of an intensive care unit. For Medicare Advantage patients, the average length of stay was 9.2 days and 44.9% included intensive care use.
However, direct expenditures for facility-only services were reported in 63 privately insured patient hospitalizations (4.3%) and 36 Medicare Advantage patient hospitalizations (1.3%). In these cases, the average personal expense amount was $ 3,840 for privately insured patients and $ 1,536 for Medicare Advantage patients.
Total personal expenses exceeded $ 4,000 in 2.5% of hospitalizations for privately insured patients, compared with 0.2% of Medicare Advantage patients.
The researchers also looked at out-of-pocket expenses for each of the three main types of professional and attendant services: ambulance, clinician, and miscellaneous.
A total of 137 (9.9%) privately insured patients and 985 (36.5%) Medicare Advantage patients had reimbursable ambulance costs; 918 (66.7%) and 595 (22.1%), respectively, had clinician-related costs.
In another clinician services subtype analysis, 516 (37.5%) of privately insured patients had direct expenditures for inpatient assessment and management services, compared to 394 (14.6%) Medicare Advantage patients. The average out-of-pocket expense for the 516 inpatient admissions and inpatient management services was $ 622 for privately insured patients and $ 162 for Medicare Advantage patients.
The study’s results were limited by several factors, primarily the inability to confirm that COVID-19-related hospitalizations were covered by cost-sharing waived plans, the researchers note. Other limitations included the inability to account for expenses for patients who did not pay what they were billed or who were not billed because they died in hospital, and inaccurate estimates potential direct expenditure by institutions due to the relatively low numbers. , write the researchers.
However, the results were bolstered by the use of a large national database that included a large percentage of older adults, who are at increased risk of hospitalization for COVID-19, they note. The results suggest not only that cost-sharing waivers by insurers may not cover all in-hospital care for COVID-19 patients, but also that the financial burden for such patients could be significant without waivers, the researchers point out. researchers.
To help protect patients from the high costs of COVID-19 hospitalizations, “Federal policymakers could consider legislation requiring insurers to forgo cost-sharing for COVID-19 hospitalizations throughout the emergency. public health, “with a mandate that would include all inpatient care, similar to current federal mandates for coverage of all direct and related costs of COVID-19 tests and vaccines, the researchers write.
“Future research should include tracking the financial burden on patients resulting from COVID-19-related hospitalizations as coverage policies change,” they conclude.
Funding for the purchase of the IQVIA data was provided in part by the Susan B. Meister Child Health Evaluation and Research Center at the University of Michigan School of Medicine. Chua revealed support from the National Institute on Drug Abuse, National Institutes of Health.
JAMA Netw Open. 2021; 4 (10): e2129894. Full Text
Heidi Splete is a freelance medical journalist with 20 years of experience.
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