AI工具造成近10億美元額外成本，藍十字藍盾保險業者表示

阿米娜・尼亞塞報導By Amina Niasse

紐約，9月24日（路透社）——藍十字藍盾協會（Blue Cross Blue Shield Association）週四發布的一項研究顯示，由於醫療服務提供者針對較嚴重的病患照護開立帳單，AI工具在兩年間使保險業者的醫療支出增加近10億美元。NEW YORK, Sept 24 (Reuters) - AI tools are raising health spending for insurers by nearly $1 billion over two years, as providers bill for more severe patient care, according to a Blue Cross Blue Shield Association study released Thursday.

該研究補充指出，2024年至2025年間，醫療服務提供者更頻繁地針對次發性疾病開立帳單，也就是源自另一種疾病、而非當下治療疾病的病況，使藍十字藍盾（BCBS）旗下公司在此期間成本增加6.53億美元。整體而言，與2023年相比，照護強度提高在這兩年間為BCBS公司帶來9.42億美元成本。Between 2024 and 2025, providers more frequently billed for secondary conditions, or those stemming from a separate illness from the one they were treating, driving costs up by $653 million for BCBS companies during that period. Overall, more intense care contributed $942 million in costs to BCBS firms over the two-year period, when compared to 2023, the study added.

BCBSA表示，醫療服務提供者使用AI技術，透過掃描既有病患病歷，或使用環境式醫療書記工具，來辨識次發性疾病；後者會被動聆聽與病患的對話，並草擬醫療紀錄。BCBSA said providers used AI technology to identify secondary conditions by scanning existing patient records or using ambient scribes, which passively listen to conversations with patients and draft medical notes.

若病患就診紀錄載明較複雜的醫療照護，保險業者支付的金額也會較高。在醫院場域中，次發性或共存疾病可被歸類為較複雜的病況。Patient visits where more complex medical care is documented command higher payments by insurers. In hospital settings, secondary or coexisting conditions can be categorized as more complex.

BCBSA產品與資料科學資深副總裁路克・喬克（Luke Chalker）表示：「如果病患真的病得更重，我們會預期看到更多治療。」“If patients are truly sicker, we'd expect to see more treatment,” said Luke Chalker, senior vice president of product and data science at BCBSA.

一名代表表示，藍十字藍盾協會擁有由31家獨立健康保險公司組成的網絡，保障超過1億人。BCBSA的研究分析了住院場域的帳單，也就是病患入住醫療機構或醫院的情況。Blue Cross Blue Shield Association has a network of 31 independent health insurance companies, covering over 100 million people, a representative said. BCBSA's study analyzed billing from inpatient settings where patients were admitted to medical facilities or hospitals.

調查發現，在接受重大腸道手術的患者中，腸道部分阻塞、體內酸負荷過高等次發性疾病，在2023年第1季至2025年第4季之間分別增加55%與33%。For people undergoing major bowel surgeries, secondary conditions like partial blockages in the intestines and an overload of acid in the body increased 55% and 33%, respectively, the survey found between the first quarter of 2023 and the fourth quarter of 2025.

Centene等健康保險業者曾表示，醫療系統使用AI工具，已導致積極或不當的給付報銷。Health insurers such as Centene have said use of AI tools by health systems has led to aggressive or inappropriate reimbursement payments.

BCBSA臨床事務副總裁拉齊亞・哈什米醫師（Dr. Razia Hashmi）表示，較複雜的健康病例，並未對應到接受腸道疾病手術者治療率提高。哈什米說，以病患被診斷出貧血為例，輸血並未增加；輸血是健康紅血球不足患者的常見治療方式。Dr. Razia Hashmi, vice president of clinical affairs at BCBSA, said more complex health cases did not correspond with higher rates of treatment for people with bowel disease surgeries. When patients were diagnosed with anemia, for example, Hashmi said blood transfusions, a common treatment for patients with a deficit in healthy red blood cells, did not increase.

喬克表示：「診斷與治療之間的落差顯示，AI辨識出的是更多可開立帳單的病況，而不是病情更重的病患。」"The disconnect between diagnoses and treatment suggests that AI is identifying more billable conditions, not sicker patients," said Chalker.

（阿米娜・尼亞塞報導；奧蘿拉・艾利斯編輯）(Reporting by Amina Niasse; Editing by Aurora Ellis)