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Insurance disparities in the outcomes of spinal cord stimulation surgery.

Publication ,  Journal Article
Huang, KT; Hazzard, MA; Babu, R; Ugiliweneza, B; Grossi, PM; Huh, BK; Roy, LA; Patil, C; Boakye, M; Lad, SP
Published in: Neuromodulation
2013

OBJECTIVES: The Affordable Care Act aims to expand health insurance and to help narrow existing health care disparities. Medicaid patients have previously been noted to be at an increased risk for impaired access to health care, delayed medical treatment, and the receipt of substandard care. Conversely, those with commercial insurance may be subject to overtreatment. The goal of this study was to evaluate how Medicaid versus commercial insurance status affects outcomes following spinal cord stimulation (SCS) surgery. MATERIALS AND METHODS: A retrospective cohort study of 13,774 patients underwent either percutaneous or paddle permanent SCS implantation, selected from the Thomson Reuter's MarketScan database between 2000 and 2009. Patients were characterized by age at initial procedure, gender, baseline comorbidity burden, procedure-associated diagnosis code, follow-up, and type of insurance (Medicaid vs. commercial insurance). Outcome measures included probability of reoperation, timing and type of reoperation, presence of postoperative complications (immediate, 30 days, and 90 days), and overall utilization of health resources postoperatively. Multivariate analysis was performed comparing the relative effect of insurance status on outcomes following initial surgery. RESULTS: Medicaid patients had greater healthcare resource utilization as measured by medications prescribed, emergency department visits, and length of stay; however, commercially insured patients had significantly higher overall costs ($110,908 vs. $64,644, p < 0.0001). Commercial and Medicaid patients did not significantly differ in their complication rates during the index hospitalization or at 30 days or 90 days postoperatively. The group were also not significantly different in their two-year reoperation rates (7.32% vs. 5.06%, p = 0.0513). CONCLUSIONS: There are substantial insurance disparities that affect healthcare utilization and overall cost following SCS. Efforts for national healthcare reform should examine system factors that will reduce socioeconomic disparities in outcomes following SCS.

Duke Scholars

Published In

Neuromodulation

DOI

EISSN

1525-1403

Publication Date

2013

Volume

16

Issue

5

Start / End Page

428 / 434

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Spinal Cord Stimulation
  • Spinal Cord Injuries
  • Retrospective Studies
  • Postoperative Complications
  • Outcome Assessment, Health Care
  • Neurosurgical Procedures
  • Neurology & Neurosurgery
 

Citation

APA
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ICMJE
MLA
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Huang, K. T., Hazzard, M. A., Babu, R., Ugiliweneza, B., Grossi, P. M., Huh, B. K., … Lad, S. P. (2013). Insurance disparities in the outcomes of spinal cord stimulation surgery. Neuromodulation, 16(5), 428–434. https://doi.org/10.1111/ner.12059
Huang, Kevin T., Matthew A. Hazzard, Ranjith Babu, Beatrice Ugiliweneza, Peter M. Grossi, Billy K. Huh, Lance A. Roy, Chirag Patil, Maxwell Boakye, and Shivanand P. Lad. “Insurance disparities in the outcomes of spinal cord stimulation surgery.Neuromodulation 16, no. 5 (2013): 428–34. https://doi.org/10.1111/ner.12059.
Huang KT, Hazzard MA, Babu R, Ugiliweneza B, Grossi PM, Huh BK, et al. Insurance disparities in the outcomes of spinal cord stimulation surgery. Neuromodulation. 2013;16(5):428–34.
Huang, Kevin T., et al. “Insurance disparities in the outcomes of spinal cord stimulation surgery.Neuromodulation, vol. 16, no. 5, 2013, pp. 428–34. Pubmed, doi:10.1111/ner.12059.
Huang KT, Hazzard MA, Babu R, Ugiliweneza B, Grossi PM, Huh BK, Roy LA, Patil C, Boakye M, Lad SP. Insurance disparities in the outcomes of spinal cord stimulation surgery. Neuromodulation. 2013;16(5):428–434.
Journal cover image

Published In

Neuromodulation

DOI

EISSN

1525-1403

Publication Date

2013

Volume

16

Issue

5

Start / End Page

428 / 434

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Spinal Cord Stimulation
  • Spinal Cord Injuries
  • Retrospective Studies
  • Postoperative Complications
  • Outcome Assessment, Health Care
  • Neurosurgical Procedures
  • Neurology & Neurosurgery