title: Lack of financial barriers to pediatric cochlear implantation: impact of socioeconomic status on access and outcomes.
abstract: OBJECTIVE
  (1) To analyze if socioeconomic status influences access to cochlear implantation in an environment with adequate Medicaid reimbursement. (2) To determine the impact of socioeconomic status on outcomes after unilateral cochlear implantation.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University Hospitals Case Medical Center and Rainbow Babies and Children's Hospital (tertiary referral center), Cleveland, Ohio.
  
  
  METHODS
  Pediatric patients (age range, newborn to 18 years) who received unilateral cochlear implantation during the period 1996 to 2008.
  
  
  METHODS
  Access to cochlear implantation after referral to a cochlear implant center, postoperative complications, compliance with follow-up appointments, and access to sequential bilateral cochlear implantation.
  
  
  RESULTS
  A total of 133 pediatric patients were included in this study; 64 were Medicaid-insured patients and 69 were privately insured patients. There was no statistical difference in the odds of initial cochlear implantation, age at referral, or age at implantation between the 2 groups. The odds of prelingual Medicaid-insured patients receiving sequential bilateral cochlear implantation was less than half that of the privately insured group (odds ratio [OR], 0.43; P = .03). The odds of complications in Medicaid-insured children were almost 5-fold greater than the odds for privately insured children (OR, 4.6; P = .03). There were 10 complications in 51 Medicaid-insured patients (19.6%) as opposed to 3 in 61 privately insured patients (4.9%). Medicaid-insured patients missed substantially more follow-up appointments overall (35% vs 23%) and more consecutive visits (1.9 vs 1.1) compared with privately insured patients.
  
  
  CONCLUSIONS
  In an environment with adequate Medicaid reimbursement, eligible children have equal access to cochlear implantation, regardless of socioeconomic background. However, lower socioeconomic background is associated with higher rates of postoperative complications, worse follow-up compliance, and lower rates of sequential bilateral implantation, observed herein in Medicaid-insured patients. These findings present opportunities for cochlear implant centers to create programs to address such downstream disparities.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Chang
authors.forename: Alvin B
authors.initials: AB
authors.lastname: Ko
authors.forename: Gail S
authors.initials: GS
authors.lastname: Murray
authors.forename: James E
authors.initials: JE
authors.lastname: Arnold
authors.forename: Cliff A
authors.initials: CA
authors.lastname: Megerian
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000191:economics* / Q000639:trends; D003054:Cochlear Implants / Q000191:economics / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D054625:Healthcare Disparities; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000191:economics* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000191:economics*; D017149:Private Sector / Q000191:economics; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States