Share this

Article Facebook

Twitter

Email You are free to share this article under the Attribution 4.0 International license. University University of Florida

Brain tumor patients who are uninsured or use Medicaid have worse outcomes across the board than patients with private insurance.

For a new study, researchers looked at nationwide data from 566,346 hospital admissions involving brain tumor cases between 2002 and 2011.

The findings show that these patients stay hospitalized longer, develop more medical complications, and are 25 percent more likely to die during their hospital stay. They are also more likely to end up in a nursing home, rehabilitation center, or hospice.

Less early detection

People who are uninsured or use Medicaid also are less likely to benefit from early detection of brain tumors because they have less access to health care than those with private insurance, says Kristopher G. Hooten, a resident in the University of Florida’s College of Medicine’s department of neurosurgery.

When brain tumor patients are hospitalized, much has already happened that affects their medical prognosis, Hooten says.

“When private-insurance patients start to have a problem, it gets picked up really fast. They go to a primary doctor, who makes a quick referral to a neurologist or neurosurgeon.”

But people who use Medicaid don’t always have that benefit, sometimes waiting and then going to an emergency room when their symptoms are more severe. That ultimately affects a patient’s outcome.

Access and quality of care

“It’s both an access-to-care and a quality-of-care issue before patients are admitted. (Uninsured or Medicaid patients) come in when their brain tumors are more advanced,” says Hooten, lead author of the study in the journal Neurosurgery.

Once hospitalized, patients with private insurance and those on Medicaid also fare differently. Medicaid patients are more prone to certain kinds of infections, postoperative respiratory issues, and problems with blood sugar control.

They also were more at risk for so-called “hospital-acquired conditions,” including pressure ulcers and vascular catheter infections. Medicaid and uninsured patients are almost twice as likely to have blood sugar problems compared with those with private insurance.

That isn’t because hospitals treated individual patients differently based on their insurance. Instead, it’s because these patients are more likely to have a broader set of medical problems.

The findings could benefit patients by identifying conditions like obesity and poor nutrition that put them at greater risk for other medical problems.

Different playing field

The findings also show how a federal agency’s current method of comparing hospitals’ quality could benefit from more precise information about patient population, says senior author Maryam Rahman, assistant professor of neurosurgery.

Hospitals that care for higher-risk Medicaid and uninsured patients should be judged differently than those that have more privately insured patients. Some hospitals might publicize a negligible complication rate for a certain condition, but that alone doesn’t tell the whole story.

“It’s not due to the fact that they’re amazing deliverers of health care, it’s just that they take care of a low-risk population,” she says.

The researchers used data from the National Inpatient Sample, the largest health care database of its kind in the United States. The sampling did not identify patients or specify the hospitals where they were treated. The findings could be helpful when implementing health care policy and to improve disparities in medical care, Rahman says.

“This type of research is important from a global standpoint to understand what goes into quality assessment, how hospitals are ranked based on quality and which patients are potentially high-risk. The true benefit is identifying areas of improvement and making things better for patients.”

Source: University of Florida