Out-of-pocket (OOP) payments for medical and surgical care can place a significant financial strain on individuals and their families. Limited information about out-of-pocket expenses for commercially insured patients undergoing orthopedic surgery is available. For a study, researchers sought to examine trends in out-of-pocket expenditures for common, elective orthopedic procedures conducted in the hospital inpatient environment.

The billing data of commercially insured patients who underwent elective orthopedic surgery between 2014 and 2019 were analyzed using an employer-sponsored insurance claims database. Single-level anterior cervical diskectomy and fusion (ACDF), single-level posterior lumbar fusion (PLF), total knee arthroplasty (TKA), and total hip arthroplasty (THA) patients were found. The number of deductible payments, copayments, and coinsurance were used to compute the out-of-pocket expenditures connected with the surgical episode. Monetary facts have been converted to 2019 dollars. For analysis, general linear regression, Wilcoxon-Mann-Whitney, and Kruskal-Wallis tests were performed when needed.

The study included 10,225 ACDF, 28,841 PLF, 70,815 THA, and 108,940 TKA patients. Most patients in our research had preferred provider organization insurance plans (ACDF 70.3%, PLF 66.9%, THA 66.2%, and TKA 67.0%). ACDF $3,180 (SD=2,495), PLF $3,166 (SD=2,529), THA $2,884 (SD=2,100), and TKA $2,733 (SD=1,994) were the mean OOP expenditures for patients. Total OOP expenses grew considerably for all operations from 2014 to 2019 (P<0.0001). Patients with high-deductible health plans had the greatest episodic OOP expenses among the insurance plans studied. The ratio of patient contribution (out-of-pocket expenses) to total insurer contribution (payments from insurers to providers) for ACDF was 0.07, 0.04 for PLF, 0.07 for THA, and 0.07 for TKA.

OOP expenditures rose from 2014 to 2019 among commercially insured patients who underwent elective spinal fusion and major lower limb joint arthroplasty surgery. As a result, OOP expenses for elective orthopedic surgery are a significant and growing financial burden for individuals.

Reference: journals.lww.com/jaaos/Abstract/2022/07150/Patient_Out_of_Pocket_Cost_Burden_With_Elective.5.aspx