title: Time to pediatric epilepsy surgery is longer and developmental outcomes lower for government compared with private insurance.
abstract: BACKGROUND
  It is unclear if socioeconomic factors like type of insurance influence time to referral and developmental outcomes for pediatric patients undergoing epilepsy surgery.
  
  
  OBJECTIVE
  This study determined whether private compared with state government insurance was associated with shorter intervals of seizure onset to surgery and better developmental quotients for pediatric patients undergoing epilepsy surgery.
  
  
  METHODS
  A consecutive cohort (n = 420) of pediatric patients undergoing epilepsy surgery were retrospectively categorized into those with Medicaid (California Children's Services; n = 91) or private (Preferred Provider Organization, Health Maintenance Organization, Indemnity; n = 329) insurance. Intervals from seizure onset to referral and surgery and Vineland developmental assessments were compared by insurance type with the use of log-rank tests.
  
  
  RESULTS
  Compared with private insurance, children with Medicaid had longer intervals from seizure onset to referral for evaluation (log-rank test, P = .034), and from seizure onset to surgery (P = .017). In a subset (25%) that had Vineland assessments, children with Medicaid compared with private insurance had lower Vineland scores presurgery (P = .042) and postsurgery (P = .003). Type of insurance was not associated with seizure severity, types of operations, etiology, postsurgical seizure-free outcomes, and complication rate.
  
  
  CONCLUSIONS
  Compared with Medicaid, children with private insurance had shorter intervals from seizure onset to referral and to epilepsy surgery, and this was associated with lower Vineland scores before surgery. These findings may reflect delayed access for uninsured children who eventually obtained state insurance. Reasons for the delay and whether longer intervals before epilepsy surgery affect long-term cognitive and developmental outcomes warrant further prospective investigations.
authors.affiliation: Department of Neurosurgery, Mattel Children's Hospital, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Hauptman
authors.forename: Andrew
authors.initials: A
authors.lastname: Dadour
authors.forename: Taemin
authors.initials: T
authors.lastname: Oh
authors.forename: Christine B
authors.initials: CB
authors.lastname: Baca
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Vickrey
authors.forename: Stefanie
authors.initials: S
authors.lastname: Vassar
authors.forename: Raman
authors.initials: R
authors.lastname: Sankar
authors.forename: Noriko
authors.initials: N
authors.lastname: Salamon
authors.forename: Harry V
authors.initials: HV
authors.lastname: Vinters
authors.forename: Gary W
authors.initials: GW
authors.lastname: Mathern
mesh_terms: D000293:Adolescent; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data*; D017149:Private Sector; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists