H. Jen1, C. Calkins2, R. Dasgupta3, S. Shah4, S. Safford5, I. Bernstein6, M. Langham7, L. Chen8 1Tufts Medical Center,Boston, MA, USA 2Medical College Of Wisconsin,Milwaukee, WI, USA 3Cincinnati Children’s Hospital Medical Center,Cincinnati, OH, USA 4Children’s Mercy Hospital – University Of Missouri Kansas City,Kansas City, MO, USA 5Virginia Tech Carilion Clinic Children’s Hospital,Roanoke, VA, USA 6University Of Texas Southwestern Medical Center,Dallas, TX, USA 7University Of Tennessee Health Science Center,Memphis, TN, USA 8Baylor University Medical Center,Dallas, TX, USA 9American Academy Of Pediatrics Section On Surgery Committee On Delivery Of Surgical Care,N/A, N/A, USA
Introduction: The Affordable Care Act has increased insurance coverage for children in the United States, but variation in out-of-pocket expenses for families with health insurance seeking pediatric surgical care for their children has also increased. Little is known about pediatric surgical specialists’ experience and attitude toward patients' insurance deductibles or whether pediatric surgical specialists take their patients’ out-of-pocket expenses into account when planning care. A national survey of pediatric surgical specialists was conducted to define the their experience with patient insurance concerns.
Methods: Members from the American Academy of Pediatrics Sections on Plastic Surgery, Surgery and Urology were asked to participate in an anonymous online survey to assess the relationship between surgeon experience with patients’ insurance plans and resource utilization. A 6-item Likert-type scale was used to assess surgeon experience with patients’ insurance concerns. A higher score on the scale associates with increased empathy and concern towards patients’ insurance status. Analysis of variance (ANOVA) was used to investigate practice pattern differences.
Results: Two hundred and eighteen out of 973 (21%) surgeons representing 38 states completed the survey. Almost half of the surveyed surgeons did not know if cost was a determinant for their patients’ choice in surgical facility (43%), or if parents compared provider costs prior to the visit (50%). If the family brought up cost or insurance coverage as an issue, the majority of surgeons would consider cheaper diagnostic modalities (84%) and adjust surgery schedules to decrease patient deductibles (94%). The minority (34%) of surgeons never considered cost as a determinant when scheduling multistage operations. The 6-item Likert-type patient insurance experience scale score did not differ significantly among surgical subspecialties, practice sizes, practice types or states of practice. Surgeons who scored lower on this scale tended to recommend laboratory and radiologic testing at their own facility, citing test reliability and accessibility to results as the top reasons for this practice (p<0.05). The majority of the surgeons surveyed (84%) would consider patient cost in their recommendation of a test or therapy if medically appropriate.
Conclusion: Pediatric surgical specialists are currently unaware if out-of-pocket cost influences patients’ preoperative decisions, but are sympathetic to the issue of out-of-pocket costs if families raised cost as an issue during their visit. As the financial burden of health care shifts to patients and families, the influence of this burden on health care choices by consumers and providers may affect both access to care and surgical outcomes.