title: Insurance disparities in the outcomes of spinal cord stimulation surgery.
abstract: OBJECTIVE
  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.
  
  
  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.
authors: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors: Kevin T
authors: KT
authors: Huang
authors: Matthew A
authors: MA
authors: Hazzard
authors: Ranjith
authors: R
authors: Babu
authors: Beatrice
authors: B
authors: Ugiliweneza
authors: Peter M
authors: PM
authors: Grossi
authors: Billy K
authors: BK
authors: Huh
authors: Lance A
authors: LA
authors: Roy
authors: Chirag
authors: C
authors: Patil
authors: Maxwell
authors: M
authors: Boakye
authors: Shivanand P
authors: SP
authors: Lad
mesh_terms: D000328:Adult; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000628:therapy*; D062187:Spinal Cord Stimulation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: Disparities; insurance coverage; socioeconomics; spinal cord stimulation