The Agency for Healthcare Research & Quality releases a series of Statistical Briefs based on the Medical Expenditure Panel Survey. The latest one describes physician visits in 2016. (AHRQ Statistical Brief) About 35% of all visits were to primary care physicians, with another 9% to pediatricians, 6% to ob/gyn, 7.4% to eye doctors, 5.5% to orthopedists and 4.6% to psychiatrists. The average expense for a physician visit was $265 across all specialties, but the median expense was only $116; which reflects a lower average visit cost for the most common specialties. Average cost for a primary care visit was $186, and it was $169 for a pediatrician and $159 for a psychiatrist. On the other end, an average bill for a trip to the orthopedist was $419 and to a cardiologist $335. 55% of all physician visits had no copayment. This also varied across specialties, with 66% of pediatrician visits not having cost-sharing and 63% of ob/gyn appointments. But only 44% of opthalmologist and 41% of dermatologist visits had no cost-sharing. Median out-of-pocket payment for those visits with some cost-sharing was $30, with a range of $25 for pediatrician and primary care doctors to $40 for orthopedists, dermatologists and eye doctors. Mean or average out-of-pocket payments were higher than median ones. For example the average cost-sharing on a pediatric visit was $40 and for ophthalmologists it was $125. Across payer types, as you might expect, Medicaid enrollees paid the least out-of-pocket, followed by Medicare beneficiaries, with commercial insureds having the greatest cost-sharing, and total expense for a visit followed a similar pattern. There was some variation among specialties depending on payer type as well. One take-away would be that there is less cost-sharing for doctor visits than one might expect, but this is probably overly influenced by the high number of people on Medicaid who have no cost-sharing in most cases.
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The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
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