Outpatient Charges Can Be Daunting For Uninsured Cancer Patients

MedicalResearch.com Interview with: Stacie B. Dusetzina PhD Assistant professor in the Eshelman School of Pharmacy and the Gillings School of Global Public Health University of North Carolina at Chapel Hill Member of the Lineberger Comprehensive Cancer CenterMedicalResearch.com Interview with:
Stacie B. Dusetzina PhD
Assistant professor in the Eshelman School of Pharmacy and the Gillings School of Global Public Health
University of North Carolina at Chapel Hill
Member of the Lineberger Comprehensive Cancer Center

Medical Research: What is the background for this study? What are the main findings?

Dr. Dusetzina: Charges for health services — the amounts providers request before payments are negotiated — have not been widely known for services delivered in physicians’ offices. Charges can be considered the maximum amount that would be paid by a person without insurance who does not or is unable to negotiate for a lower price. In this study we used recently released data from the Medicare Provider Utilization and Payment Public Use File and other sources to measure what physicians charged for chemotherapy drugs delivered intravenously in 2012 and the amounts reimbursed by Medicare and private health plans for the same services.

We found that uninsured cancer patients may be asked to pay from 2 to 43 times what Medicare pays for chemotherapy drugs. Medicare and insurers don’t pay the sticker price of health care. They pay a discounted rate. However, uninsured patients don’t have the bargaining power, or they may not try to negotiate for a better price. On average, Medicare paid approximately 40 percent of the charged amounts for chemotherapy drugs. Private insurers paid nearly 57 percent of the charged amounts on average. We also looked at what cancer patients were asked to pay for an office visit. Uninsured patients may be asked to pay from $129 to $391, depending on the complexity of the visit. Medicare paid between $65 and $188 and private insurance paid between $78 and $246 for the same visits.

Medical Research: What should clinicians and patients take away from your report?

Dr. Dusetzina: There is a lot of variation in charges and the prices paid for health services delivered in physicians’ offices. Uninsured patients who do not negotiate may ultimately pay more than insurers pay for those same services. In this study, we found that, on average, patients without insurance pay twice as much or more than insurers pay for chemotherapy.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Dusetzina: More work is needed to determine whether uninsured patients are able to receive needed health services and how much patients ultimately paid for services they did receive. Increasing transparency in health service pricing may also help consumers to understand what payments are expected from them for services delivered.

Citation:

For Uninsured Cancer Patients, Outpatient Charges Can Be Costly, Putting Treatments Out Of Reach

Stacie B. Dusetzina, Ethan Basch, and Nancy L. Keating

Health Aff April 2015 34:4584-591; doi:10.1377/hlthaff.2014.0801

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MedicalResearch.com Interview with: Stacie B. Dusetzina PhD (2015). Outpatient Charges Can Be Daunting For Uninsured Cancer Patients