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How Much Should Hand Surgery Cost: The Patient Perspective
Elizabeth P. Wahl, MD1; Suhail K. Mithani, MD2; Joel Huber, MBA, Ph.D3; Marc J. Richard, MD4; Tyler S. Pidgeon, MD1
1Duke University Medical Center, Durham, NC; 2Plastics and Reconstructive Surgery, Duke University Medical Center, Durham, NC; 3Duke University Fuqua School of Business, Durham, NC; 4Orthopedic Surgery, Duke University Medical Center, Durham, NC

In light of the ever-rising cost of healthcare, providers, payers and patients are continuously searching for methods to reduce expense while maintaining quality. For healthcare consumers (patients), medical expenses are uniquely difficult to navigate due to the lack of transparency in pricing and limited patient knowledge in understanding what defines quality. Nevertheless, understanding patient expectations on out-of-pocket costs is important to both providers and payers.This study seeks to define the maximum out-of-pocket price that a patient undergoing a common hand surgery procedure is willing to pay. It also queries the potential cost-cutting measures patients are most and least comfortable with. We hypothesize that respondents will be less accepting of the higher out-of-pocket costs.

A survey was developed in conjunction with marketing experts and distributed digitally to paid, anonymous respondents. The survey gathered demographic information and introduced three hand surgery procedures, carpal tunnel release (CTR), cubital tunnel release (CuTR) and open reduction and internal fixation of a distal radius fracture (ORIF DRF). Respondents were randomized to one of five out-of-pocket price options for each procedure and asked if they would pay that price. Respondents were then presented with various cost-saving methods (Table 2) and asked to select up to five options that made them most uncomfortable, even if it would save them out-of-pocket costs. Descriptive statistics were performed.

There were 1451 respondents. The mean respondent age was 40.0 (range 18-74 years) and 66% were male. Table 1 presents the results for the respondentsí willingness to pay for each price for each procedure and table 2 presents the results for the aspects of care that respondents were most uncomfortable with cost-cutting.

For each price presented for each procedure, over 80% of respondents were willing to pay the proposed price. CTR had the greatest percentage point difference. This suggests that many patients are willing to pay up to and over $3000 out-of-pocket for hand surgery procedures when they are educated on the surgery, its necessity, and the risks and benefits. Respondents were least willing to cut cost on implants, anesthesia care, and the hospital setting of the procedure.

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