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. 2020 Jun;145(6):1541-1551.
doi: 10.1097/PRS.0000000000006847.

The Economic Burden of Out-of-Pocket Expenses for Plastic Surgery Procedures

Jessica I Billig  1 , Jung-Sheng Chen  1 , Yu-Ting Lu  1 , Kevin C Chung  1 , Erika D Sears  1
Affiliations

The Economic Burden of Out-of-Pocket Expenses for Plastic Surgery Procedures

Jessica I Billig et al. Plast Reconstr Surg. 2020 Jun.

Abstract

Background: Health insurance reimbursement structure has evolved, with patients becoming increasingly responsible for their health care costs through rising out-of-pocket expenses. High levels of cost sharing can lead to delays in access to care, influence treatment decisions, and cause financial distress for patients.

Methods: Patients undergoing the most common outpatient reconstructive plastic surgery operations were identified using Truven MarketScan databases from 2009 to 2017. Total cost of the surgery paid to the insurer and out-of-pocket expenses, including deductible, copayment, and coinsurance, were calculated. Multivariable generalized linear modeling with log link and gamma distribution was used to predict adjusted total and out-of-pocket expenses. All costs were inflation-adjusted to 2017 dollars.

Results: The authors evaluated 3,165,913 outpatient plastic and reconstructive surgical procedures between 2009 and 2017. From 2009 to 2017, total costs had a significant increase of 25 percent, and out-of-pocket expenses had a significant increase of 54 percent. Using generalized linear modeling, procedures performed in outpatient hospitals conferred an additional $1999 in total costs (95 percent CI, $1978 to $2020) and $259 in out-of-pocket expenses (95 percent CI, $254 to $264) compared with office procedures. Ambulatory surgical center procedures conferred an additional $1698 in total costs (95 percent CI, $1677 to $1718) and $279 in out-of-pocket expenses (95 percent CI, $273 to $285) compared with office procedures.

Conclusions: For outpatient plastic surgery procedures, out-of-pocket expenses are increasing at a faster rate than total costs, which may have implications for access to care and timing of surgery. Providers should realize the increasing burden of out-of-pocket expenses and the effect of surgical location on patients' costs when possible.

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Figures

Figure 1:
Figure 1:
Inclusion and Exclusion Criteria
Figure 2:
Figure 2:
Total Cost (2009–2017)
Figure 3:
Figure 3:
Out-of-Pocket Expenses (2009–2017)
Figure 4:
Figure 4:
Out-of-Pocket Expenses Stratified by Surgical Location (2009–2017)
See this image and copyright information in PMC

Comment in

References

    1. American Society of Plastic Surgeons. 2017. Plastic Surgery Statistics Report. 2017; https://www.plasticsurgery.org/documents/News/Statistics/2017/plastic-su....
    1. Gilligan AM, Alberts DS, Roe DJ, Skrepnek GH. Death or Debt? National Estimates of Financial Toxicity in Persons with Newly-Diagnosed Cancer. Am J Med. 2018;131(10):1187–1199 e1185. - PubMed
    1. Narang AK, Nicholas LH. Out-of-Pocket Spending and Financial Burden Among Medicare Beneficiaries With Cancer. JAMA Oncol. 2017;3(6):757–765. - PMC - PubMed
    1. Kelley RK, Venook AP. Nonadherence to imatinib during an economic downturn. New England Journal of Medicine. 2010;363(6):596–598. - PubMed
    1. Hirth RA, Greer SL, Albert JM, Young EW, Piette JD. Out-of-pocket spending and medication adherence among dialysis patients in twelve countries. Health Aff (Millwood). 2008;27(1):89–102. - PubMed

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