title: Access of Patients With Lumbar Disc Herniations to Spine Surgeons: The Effect of Insurance Type Under the Affordable Care Act.
abstract: METHODS
  Prospective cohort study.
  
  
  OBJECTIVE
  To determine the effects of insurance type (Medicaid vs. a specific private insurance) on patient access to spine surgeons for lumbar disc herniation as measured by (A) acceptance of insurance, (B) need for a referral, and (C) wait time for appointment.
  
  
  BACKGROUND
  Limited studies have been conducted to examine the issue of patient access to spine surgeons based on different insurance types (Medicaid vs. a specific private insurance), especially in relation to the Medicaid expansion that resulted from the Affordable Care Act.
  
  
  METHODS
  Appointment success rates, the need for a referral, and waiting periods were compared between Medicaid and a specific private insurance for patients needing an evaluation for a herniated lumbar disc. The waiting period was studied in the context of comparing states that have expanded Medicaid eligibility to ones that have not, and the surgical training of the spine surgeon (orthopaedic surgeons vs. neurosurgeons).
  
  
  RESULTS
  Appointment success rate for patients seeking access to lumbar spine care was significantly higher for patients with BlueCross insurance (95.0%) versus patients with Medicaid insurance (0.8%) (P <0.001). The need for referrals was significantly higher for patients with Medicaid insurance (93.3%) versus patients with BlueCross insurance (4.2%) (P <0.001). Among BlueCross patients, wait times were longer in Medicaid-expanded states. However, the same trend was not seen among patients with Medicaid insurance.
  
  
  CONCLUSIONS
  Patients with Medicaid were less successful at scheduling an appointment and faced more barriers to care, such as the need for a referral, compared with the private insurance studied. In the states with expanded Medicaid, wait times for appointments were longer for BlueCross patients, but were not longer for patients with Medicaid insurance. Overall, this study suggests that increased coverage resulting from Medicaid expansion does not necessarily equate to increased access to care.
  
  
  METHODS
  2.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
authors.forename: Nidharshan S
authors.initials: NS
authors.lastname: Anandasivam
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Wiznia
authors.affiliation: Department of Orthopaedics, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH.
authors.forename: Chang-Yeon
authors.initials: CY
authors.lastname: Kim
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
authors.forename: Ameya V
authors.initials: AV
authors.lastname: Save
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Grauer
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Pelker
mesh_terms: D054598:Blue Cross Blue Shield Insurance Plans / Q000191:economics / Q000639:trends; D015331:Cohort Studies; D006297:Health Services Accessibility / Q000191:economics / Q000639:trends*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000639:trends*; D007348:Insurance, Health / Q000191:economics / Q000639:trends; D007405:Intervertebral Disc Displacement / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008484:Medicaid / Q000191:economics / Q000639:trends; D000069471:Neurosurgeons / Q000191:economics / Q000639:trends*; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000639:trends*; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists