Disparity seen in spine care delivery for patients with private vs. public insurance

Patients with public insurance who undergo lumbar surgery have more comorbidities than patients with private insurance, according to a presenter.

Population-based disparities do exist when patients with either public insurance or private insurance undergo elective lumbar spine surgery for degenerative conditions, according to findings from a recent study.

Saniya S. Godil, MD, and colleagues conducted the study, which showed the disparities were significant between the two groups.

“Significant disparities exist in patient populations in public vs. private insurance. Patients with public health plans are significantly older, comorbid and unemployed when compared with patients in a private group. They undergo extensive spine surgery with lesser improvements when compared with the private group, as well,” she said during a presentation.

Disparities between groups

Five hundred nineteen patients who underwent elective lumbar spine surgery for degenerative conditions over a 1.5-year period at a single medical center were included in a prospective longitudinal registry that Godil and colleagues studied. Patient demographics, disease characteristics, treatment variables, readmissions/reoperations and all instances of 90-day surgical morbidity were recorded.

At baseline and at 1 postoperative year investigators tracked the patients based on various patient reported outcomes, as well as their return-to-work and patient satisfaction scores.

There were 283 patients in the private insurance group and 236 patients in the public group.

Age differences noted

Godil noted the public insurance group had a statistically significantly higher mean age, which was 62.4 years compared with a mean age of 51.9 years for the private insurance group.

“Looking at the comorbidities, you can see the public insurance group was significantly higher than compared with the private insurance group,” Godil said.

Racial disparity between the groups was also observed. There was a higher percentage of African-Americans (9.7%) in the public insurance group compared to the private insurance group (4.9%).

In terms of employment difference, 17.5% of the patients in the public insurance group were employed and 61.4% of the private insurance group were employed.

More surgery, lesser improvement

“You can also see the mean number that was operated on was significantly higher for the public group. Mean length of surgery was higher. Length of stay was higher and there was a distinct difference in the types of procedures that were performed between the two groups,” Godil said. “Higher fusion rates for the public insurance group vs. the private group could be seen, as well,” she said

For the patient reported outcomes, which included the Numerical Rating Scale (NRS) for leg pain (LP) and for back pain (BP), Oswestry Disability Index, SF-12 PCS, SF-12 MCS, EuroQol-5D, Zung Depression Scale and the MSPQ anxiety scale, Godil noted the private insurance group significantly outperformed the public insurance group in every one of the outcomes, except the NRS-BP.

“We looked at 12-month patient reported outcomes and there was no difference in back pain and leg pain scores, but if you look at the quality of life outcomes you can clearly see there was a distinct difference in the two groups,” she said.

Based on results of the study, the public insurance group reported less improvement at 12 months compared with the private insurance group. – by Robert Linnehan

Reference:

Godil SS. Paper #711. Presented at: American Association of Neurological Surgeons Annual Meeting; April 5-9, 2014; San Francisco.

For more information:

Saniya S. Godil, MD, can be reached at the University of Vanderbilt Department of Neurological Surgery, 2201 West End Ave., Nashville, TN 37235; email: saniya.godil@vanderbilt.edu.

Disclosure: Godil has no relevant financial disclosures.