National Trends in Utilization and Expenditures for Plastic Surgery From 2002 to 2022: A Cross-Sectional Study.

Background and Aims: Shifting patterns in the financing of plastic surgery are not fully understood. We analyze payer trends for office and outpatient plastic surgery visits from 2002 to 2022. Methods: We investigated office-based and hospital outpatient department plastic surgery visits in the Medical Expenditure Panel Survey, a national dataset of healthcare usage and expenditures. During the study period (2002-2022), we calculated the yearly median amount of money charged and paid per visit, the distribution of payer type expenditures, and the mean payment-to-charge ratio per visit. Dollar amounts were inflation-adjusted to 2022 estimates. Results: From 2002 to 2022, there were 5824 office-based plastic surgery visits and 850 outpatient department plastic surgery visits, representing 71,597,980 and 10,589,575 total visits, respectively. For office-based visits, the number of visits declined across the study period from 3,982,280 to 1,418,032 (-64.4%), the median (IQR) payment per visit increased from $119.06 ($188.49) to $263.48 ($721.35) (+121.3%), and the median (IQR) payment-to-charge ratio decreased from 0.71 (0.43) to 0.47 (0.45) (-33.8%). Payments were primarily private insurance (37.6%) and out-of-pocket (36.0%). For outpatient department visits, the median (IQR) payment-to-charge ratio also decreased significantly from 0.56 (0.44) to 0.35 (0.45) (-37.1%); median (IQR) payment per visit was $1587.93 ($1287.80) without significant changes over time. Most expenditures were from private insurance (58.5%), then self-pay (17.8%), and Medicare (11.7%). Conclusion: National trends in plastic surgery expenditures show decreasing payment-to-charge ratios for both office and outpatient department settings. However, the payer mix driving these trends differs by practice setting. Limitations of the study include survey-based data, a small sample size, and the exploratory nature of the study with limited statistical analysis. Further research is warranted to uncover factors that may account for these findings and their implications.