Disparities in Elective Spine Surgery for Medicaid Beneficiaries: A Systematic Review

Abstract

Study Design Systematic review Objectives We sought to synthesize the literature investigating the disparities that Medicaid patients sustain with regards to 2 types of elective spine surgery, lumbar fusion (LF) and anterior cervical discectomy and fusion (ACDF). Methods Our review was constructed in accordance with Preferred Reporting Items and Meta-analyses (PRISMA) guidelines and protocol. We systematically searched PubMed, Embase, Scopus, CINAHL, and Web of Science databases. We included studies comparing Medicaid beneficiaries to other payer categories with regards to rates of LF and ACDF, costs/reimbursement, and health outcomes. Results A total of 573 articles were assessed. Twenty-five articles were included in the analysis. We found that the literature is consistent with regards to Medicaid disparities. Medicaid was strongly associated with decreased access to LF and ACDF, lower reimbursement rates, and worse health outcomes (such as higher rates of readmission and emergency department utilization) compared to other insurance categories. Conclusions In adult patients undergoing elective spine surgery, Medicaid insurance is associated with wide disparities with regards to access to care and health outcomes. Efforts should focus on identifying causes and interventions for such disparities in this vulnerable population.

Lower Neighborhood Socioeconomic Status May Influence Medical Complications, Emergency Department Utilization, and Costs of Care After 1-2 Level Lumbar Fusion

“…[34][35][36][37]40,41 As previously discussed by multiple groups, postoperative ED utilization was increased in patients undergoing various orthopedic interventions for those considered to be living in disparaged socioeconomic conditions. [34][35][36][37] This increased utilization potentially are responsible for the increased expenditures as patients would be utilizing emergency health care services at a greater rate, and therefore could accumulate higher expenses. Another factor that could be responsible for the increased health care expenditures involves the location of the surgery and whether it is inpatient or outpatient.…”

“…In addition, Lieber et al 33 , using the National Inpatient Sample database, isolated patients undergoing primary 1-to 2-level The greater ED utilization, among patients living in greater deprivation indices, in this study are agreeable with what was reported in prior investigations (9.67% vs. 8.91%; OR: 1.10, 95% CI, 1.02-1.18, P = 0.014). [34][35][36][37] Jain et al 34 completed a study using the PearlDiver database from the years 2007 to 2015, isolating patients who underwent primary lumbar fusion and found increased odds for ED utilization within 30 days, postoperatively (adjusted OR: 1.42, 95% CI, 1.28-1.57, P < 0.001). It should be noted that although Jain and colleagues found increased odds for ED utilization after lumbar fusion, they utilized a 30-day follow-up period, whereas this study used a 90-day follow-up period.…”

Payor Type is Associated With Increased Rates of Reoperation and Health-care Utilization Following Unicompartmental Knee Arthroplasty: A National Database Study

“…Several studies have demonstrated that different payor types are associated with different rates of complication following various orthopedic procedures and surgeries. For example, a systematic review of spine surgeries determined that patients with Medicaid insurance were associated with decreased access to surgery, lower reimbursement rates, and worse health-care outcomes than non-Medicaid patients [ 4 ]. Furthermore, a study by Kim et al.…”

Variation in Commercial Insurance Type Impacts Access to Cervical Spine Surgery

“…1,2 A body of literature including a recent systematic review has demonstrated wide disparities with regard to access and outcomes in patients with Medicaid insurance undergoing spine surgery. 3 Medicaid and other public plans pay providers substantially lower rates for health services rendered compared with commercial plans. 4 Among commercial insurance plans, which are largely employer sponsored, there is variation in plan structure.…”

“…In the United States, disparities exist in access to surgical care and perioperative outcomes based on patient insurance status 1,2 . A body of literature including a recent systematic review has demonstrated wide disparities with regard to access and outcomes in patients with Medicaid insurance undergoing spine surgery 3 . Medicaid and other public plans pay providers substantially lower rates for health services rendered compared with commercial plans 4 …”