Out-of-Pocket Expenditures for Imaging Examinations: Perspectives from National Patient Surveys Over Two Decades.

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PURPOSE: Using national surveys, we longitudinally studied imaging costs-and specifically those paid out-of-pocket (OOP) by patients-over two decades.

METHODS: Using 2000-2019 Medical Expenditure Panel Survey (MEPS) data, we identified all imaging-focused encounters (mammography, radiography, ultrasonography (US), and computed tomography (CT) & magnetic resonance (MR) [surveyed together in MEPS]) and calculated mean overall and OOP encounter costs. Effects of sociodemographic, personal, and clinical factors were measured using logistic regression and generalized linear modeling.

RESULTS: We identified 102,717 patients (mean 45.6 years; 64.8% female; 58.8% white) undergoing 229,010 imaging-focused encounters. Between 2000 and 2019, mean costs of mammography, radiography, and US increased 14.5%, 24.5%, and 40% while total mean cost of CT/MR decreased by 15.1%. OOP costs were incurred by 51%. Overall mean OOP costs increased 89.8% from 2000 to 2019. Mean OOP costs for mammography decreased by 32.9%; mean OOP costs for radiography, US, and CT/MR increased 81%, 123.2%, and 61%, respectively. Patients were less likely to incur OOP costs when older, of racial/ethnic minorities, female, or recipients of public only (vs. private) insurance. Among those with OOP costs, the presence of comorbidities, lack of insurance, younger age, and history of cancer significantly increased OOP costs.

CONCLUSION: Mean overall patient OOP costs for imaging examinations increased significantly and substantially over the last two decades. Lack of insurance, younger age, history of cancer, and other comorbidities were associated with higher OOP costs. As diagnostic imaging utilization increases, patient financial hardship considerations merit further attention.

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Journal of the American College of Radiology

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This article was published in Journal of the American College of Radiology.

The published version is available at https://doi.org/10.1016/j.jacr.2022.07.014.

Copyright © 2022 American College of Radiology.

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