Private Insurance Patients Research Articles

The impact of insurance status on psoriasis patients’ healthcare-seeking behavior: a population-based study in the United States

BackgroundPsoriasis is a chronic, inflammatory skin condition requiring long-term care. However, many psoriasis patients may not regularly receive care. Several factors affect access to care in the United States, including health insurance status. Additionally, it is unknown how health insurance status impacts the healthcare-seeking behavior of psoriasis patients. Healthcare-seeking behavior is broadly defined as an individual’s actions to prevent or treat a perceived health problem, such as visiting a physician’s office. Because early diagnosis and timely treatment improve patient outcomes, determining how insurance status impacts psoriasis patients’ healthcare-seeking behavior and their ability to get care is important. This allows us to identify patients at risk for being untreated or undertreated. In this study, we aimed to assess the relationship between insurance status and (1) the degree to which psoriasis patients delay seeking or receiving care and (2) the degree to which psoriasis patients are unable to obtain care.MethodsThis population-based study used 20 years of data from the Medical Expenditure Panel Survey from 2002 to 2021. We calculated descriptive statistics and performed adjusted multivariable logistic regression analyses.ResultsWe identified a weighted total of 4,506,850 psoriasis patients. Compared to those with private insurance, psoriasis patients with public-only insurance were 2.7 times more likely to delay seeking or receiving care (95% CI, 1.26–5.87). Compared to private insurance patients, uninsured psoriasis patients were 3.4 times more likely to be unable to obtain care (95% CI, 1.31–8.92). Compared to those with public-only insurance, uninsured psoriasis patients were 3.7 times more likely to be unable to obtain care (95% CI, 1.32–10.38).ConclusionsThis study found that psoriasis patients with public-only insurance were significantly more likely to delay seeking or receiving care compared to those with private insurance. This study also found that uninsured psoriasis patients were significantly more likely to be unable to obtain care than psoriasis patients with private insurance and those with public-only insurance. Developing strategies to increase healthcare access is necessary to ensure equitable, timely, and appropriate care for all psoriasis patients, regardless of their insurance status.

Socioeconomic Disparities in the Clinical Outcomes of Pediatric Traumatic Brain Injury: A Nationwide Analysis of the Past Decade

Socioeconomic status has historically influenced traumatic brain injury (TBI) outcomes, yet pediatric TBI disparities remain understudied. We aimed to analyze the National Inpatient Sample (NIS) database for socioeconomic disparities in the outcomes of pediatric TBI patients. The NIS from 2011 to 2020 was retrospectively analyzed for pediatric TBI patients. Socioeconomic variables included age, sex, race, household income, geographic location, and primary expected payer. Outcomes included length of stay (LOS), in-hospital mortality, mortality risk, and illness severity. A total 45,109 pediatric TBI patients (63.9% male) were identified. Mean age was 7.76 years, mean LOS was 4.57 days, and overall mortality rate was 3.2%. African-American or Native American patients had significantly longer LOS (1.6 and 3.4 days, respectively; p<0.01) than White patients. African-American patients had an odds ratio of mortality of 1.57 compared to White patients. Female patients had significantly higher mortality risk and LOS (0.5 days) than male patients (p<0.001). Patients in the bottom 50% of income and those in rural counties had higher odds of mortality (2.20 and 1.27, respectively) compared to higher-income and urban patients. Regional mortality rate differences were significant (p<0.001), with the East South Central region having the highest rate. Medicaid and self-pay patients had higher LOS (p<0.001) and odds ratios of mortality (1.19 and 2.36, respectively) compared to private insurance patients. This study highlights significant differences based on race, sex, income, insurance type, and geographic location in pediatric TBI outcomes. Future research should focus on identifying factors contributing to inequalities and developing strategies to mitigate them.

Abstract 4138794: Risk Factors of Cumulative Limb Amputation in Patients with Thromboangiitis Obliterans (Buerger's Disease): Insights from Nationwide Inpatient Sample

Background: Thromboangiitis obliterans (TAO) is a rare, nonatherosclerotic, inflammatory disease that typically onsets in male patients at young age with heavy smoking. TAO commonly affects small and medium-sized arteries in extremities, and up to 1/3 of patients with TAO will experience limb amputation. However, the role of social determinants of health (SDoH) are not well studied in TAO patients with limb amputation in a real-world dataset. Methods: A cross-sectional study was performed in Nationwide Inpatient Sample (NIS) of United States, from calendar year 2016-2021. The diagnosis of diseases was identified by ICD-10-CM codes. Univariable logistic regression analysis was performed to identify characteristics associated with cumulative limb amputation (CLA). Stepwise multivariate logistic regression model was further employed to analyze association between significant characteristics and CLA. Results: In this study, 33.3% (N=432) patients with TAO (N=1297) had CLA. Variables showed significant association with CLA identified by univariable analysis were further included in stepwise multivariate logistic regression model. In the multivariate model, middle-age patients had higher risk of CLA than young patients (OR=1.41, 95% CI=1.00-1.99, p=0.050). Female showed lower CLA risk than male patients (OR=0.53, 95% CI=0.41-0.69, p&lt;0.001). Black patients showed higher CLA risk than White (OR=1.82, 95% CI=1.24-2.68, p=0.002). Compared to Medicare insurance, self-pay (OR=0.51, 95% CI=0.30-0.87, p=0.014) and Private insurance (OR=0.69, 95% CI=0.49-0.97, p=0.035) patients had lower CLA risk. Higher socioeconomic status associated with lower CLA risk, and patients in the 3 rd percentile had significantly lower CLA risk than those in the 1 st percentile (OR=0.68, 95% CI=0.49-0.95, p=0.028). Patients with tobacco smoking showed higher CLA risk (OR=2.11, 95% CI=2.49-3.00, p&lt;0.001). Conclusions: The CLA rate was up to 33.3% among the TAO patients in NIS 2016-2021. SDoH like age, sex, race, insurance type and socioeconomic status showed significant association with CLA risk in TAO patients. Further studies are warranted to explore mechanism, health equity and multidisciplinary care to decrease CLA for patients with TAO.

Insurance remains a major source of disparity for patients with testicular cancer: call for advocacy.

To evaluate the effects of socioeconomic factors, including insurance status, on treatment and survival for patients with testicular cancer. We extracted a retrospective cohort from the National Cancer Database that included patients diagnosed with testicular cancer 2004-2020. Competing-risks and Cox regression multivariate models including demographic, pathological, and socioeconomic covariates were constructed to evaluate receipt of treatment and death, respectively. A total of 95 955 patients with testicular cancer were identified. Compared with private insurance, Medicaid (sub-distribution hazard ratio [SHR] 0.70, P < 0.001), Medicare (SHR 0.73, P < 0.001), and uninsured (SHR 0.72, P < 0.001) patients were associated with decreased likelihood of receiving chemotherapy. Compared with private insurance, Medicaid (SHR 0.55, P < 0.001), Medicare (SHR 0.76, P-value <0.001), uninsured (SHR 0.63, P-value < 0.001), and other government insurance (SHR 0.71, P = 0.010) was associated with decreased likelihood of receiving radiation. Medicaid insurance status (reference private, HR 2.60, P < 0.001) conferred the second largest hazard of death, behind having Stage III disease (reference Stage 0). Compared with private insurance, Medicare (HR 2.20, P < 0.001), no insurance (HR 2.32, P < 0.001), and other government insurance (HR 1.53, P = 0.027) statuses had higher risk of death. Patients diagnosed in Medicaid-expansion states had lower all-cause mortality (11.4% vs 13.6%, P < 0.001). Testicular cancer care relies on early diagnosis and treatment. It is critically important to have a healthcare system where individuals have access to insurance and are served equitably.

Examining Impact of Insurance Type on Genetic Testing in Pediatric Neurology

BackgroundStudies that examine the impact of insurance type on the ease of obtaining genetic testing are scarce. Therefore, we aim to analyze how different types of insurance influence the time taken to obtain genetic test results among pediatric neurology patients. MethodsThis was a retrospective cohort study from Dayton Children’s Hospital. Patients who had at least one neurological genetic result found in the electronic medical record from January 1, 2014, to March 1, 2023, were included in the study. Variables collected include demographics, health insurance data, and genetic testing results. ResultsA total of 141 patients were included. Most patients were male (51.8%), white (78.0%), and not Hispanic/Latino (96.5%). The mean age at the time of genetic testing was 7.9 years. Most patients had Medicaid as their primary insurance (60.3%) when compared with private insurance (39.7%). Two hundred fifteen genetic reports were examined (137 Medicaid charts and 78 private insurance charts). There was no statistically significant difference from mean time lapse between test order date and results date for Medicaid patients (27.3 days) versus private insurance (31.5 days, P = 0.40). Molecular genetics testing and epilepsy gene panel order were the most common tests ordered for both Medicaid (86.1%, 37.2%) and private insurance (88.5%, 39.7%, respectively). ConclusionsThe mean time between test order date and results date was comparable between private- and Medicaid-insured patients. Our results suggest that there is no significant difference for time to result between pediatric neurology patients who carry public versus private insurance for genetic testing.

TCT-58 Use of Intravascular Ultrasound During Percutaneous Coronary Intervention Does Not Reduce All-Cause In-Hospital Mortality but Doubles the Cost, With Higher Use in Privately Insured Patients

TCT-58 Use of Intravascular Ultrasound During Percutaneous Coronary Intervention Does Not Reduce All-Cause In-Hospital Mortality but Doubles the Cost, With Higher Use in Privately Insured Patients

Financial burden within first year of diagnosis for privately-insured patients with early-onset breast or colorectal cancer.

9 Background: Rising incidence of early-onset (E-O) cancers has been observed globally. E-O breast cancer (BC) are patients (pts) diagnosed ages 18 to 44 and E-O colorectal cancer (CRC) are aged 18 to 49. Because many E-O cancers are among pts who do not meet screening eligibility criteria by age, they are often diagnosed at advanced stage, which is also more expensive to treat. Younger pts may also have lower incomes and fewer assets, increasing risk of financial burden for pts with E-O cancers. We estimated the financial burden for pts and private payors for E-O BC and CRC, compared to non-elderly pts with BC and CRC diagnosed between the age of 45 to 64 and 50 to 64 (older-onset), respectively. Methods: We applied a claims-based algorithm to identify pts with incident BC and CRC diagnosed between 2014 and 2021 from MarketScan Commercial Claims and Encounters Data and required 12-month continuous enrollment before and after the index diagnosis for completeness of claims. Financial burden was quantified as total and out-of-pocket (OOP) payments, calculated as the sum of deductibles, copayments, and coinsurance. We used generalized linear models and quantile regressions to compare differences in mean and median costs, respectively, between pts with E-O vs. older onset cancer, adjusting for comorbidity, region, insurance plan type, sex (for CRC) and year. Results: Study cohort included 58,419 pts with BC and 11,251 pts with CRC. The proportion of E-O increased from 15% in 2014 to 17% in 2022 (Ptrend&lt;0.01) in BC and from 23% to 30% (Ptrend&lt;0.01) in CRC. Higher percentage of E-O pts were enrolled in high-deductible plans (BC: 25% v22%; CRC: 24% vs. 21%) and received systemic therapy (BC: 61% v 49%; CRC: 57% vs. 43%). Higher percent of surgery (93% v 89%) was observed in E-O BC and radiation (21% v 16%) in E-O CRC. Pts with E-O BC and CRC had significantly higher adjusted mean and median total and OOP payments (Table). Conclusions: E-O BC and CRC result in substantial costs to payors and moderately higher OOP payments. OOP maximums in private insurance may offer some financial protection for pts. E-O Older onset Difference 95% CIBC: BC: Mean total pay $182,770 $128,640 $54,130 $50445, $57817 Median total pay 143,351 93,317 50,034 47691, 52377 Mean OOP 6,014 5,063 951 817, 1085 Median OOP 5,142 4,258 884 791, 978 CRC: Mean total pay $153,446 $123,449 $29,998 $24244, $35752 Median total pay 119,747 89,340 30,406 25216, 35597 Mean OOP 5,429 4,791 638 428, 848 Median OOP 4,452 4,015 437 266, 607

Acceptable outcomes of liver transplantation in uninsured patients under the coverage of a state assistance program.

The lack of health insurance is a major barrier in the access to healthcare even in case of life-saving procedures such as liver transplantation (LT). Concerns about worse outcomes in uninsured patients have also discouraged the evaluation and transplantation of patients without adequate health insurance coverage. The aim of this study is to evaluate outcomes from the largest cohort of uninsured patients who underwent LT with the support of a state payment assistance program (also called charity care). This study included all consecutive patients who underwent LT at a single center from 2002 to 2020. Demographic, clinical, social variables and outcome metrics were collected and compared between insured and uninsured patients. Among a total of 978 LT recipients, 594 had private insurance, 324 government insurance (Medicare/Medicaid), 60 were uninsured and covered under a state charity care program. In the charity care group, there was a higher proportion of Hispanic subjects, single marital status, younger age, and high-MELD score patients. The 1- and 3-year patient survival rates were 89.0% and 81.8% in private insurance patients, 88.8% and 80.1% in government insurance recipients, and 93.3% and 79.6% in those with charity care (p=0.49). There was no difference in graft survival between insured and uninsured patients (p=0.62). The three insurance groups presented similar hospital length-of-stay and 30-day readmission rates. In both univariate and multivariate analysis, uninsured status (charity care) was not associated with worse patient survival (HR:1.23, 95%CI: 0.84-1.80, p=0.29) or graft survival (HR:1.22, 95%CI:0.84-1.78, p=0.29). In conclusion, there was no difference in outcomes after LT between insured and uninsured patients. A charity care program may be an effective tool to mitigate socio-economic disparities in both outcomes and access to LT.

Insurance Status, Language, and Access to Care for Pediatric Anterior Cruciate Ligament Injury.

Patients with public insurance (PUBs) face more difficulty obtaining orthopaedic appointments and have longer wait times than privately insured patients (PVTs). These delays are associated with greater injury severity at the time of surgery, which affects sports injuries such as anterior cruciate ligament tears where early surgical stabilization leads to better outcomes. Additionally, previous evidence showed that patients with limited English proficiency often must rely on informal translation services, such as family members or friends, to communicate with their orthopaedic surgeons, which may represent a disparity in the care provided. It was hypothesized that PUBs would be less likely to obtain an appointment compared with PVTs and that most providers would not offer professional translation services to Spanish-speaking patients. Cross-sectional study. The authors called 50 randomly selected orthopaedic surgeons' offices in California specializing in sports medicine to request an appointment. Each office was called 4 times in random order for the hypothetical patient having either private or public insurance and speaking either Spanish or English. The hypothetical PUB had significantly decreased access to an appointment (19% of offices offered an appointment) when compared to the PVT (73.8% offered an appointment). Independent private practice (IPP) offices were less likely to accept public insurance (13.3%) compared with offices at academic medical centers (57.1%). There was no difference in access to an appointment for the Spanish- versus English-speaking patient. Translation services were offered at 73.8% of the orthopaedic offices. Overall, the data illustrated disparities in access to pediatric orthopaedic care for PUBs compared to those with private insurance. Disparities were most prominent in IPP settings, which were less likely than academic offices to accept public insurance. Additionally, it was found that 73.8% of the offices the authors contacted offered Spanish translation services. Interventions should focus on increasing acceptance of public insurance and translation services in IPP settings. Future studies should expand this analysis to other languages and investigate the potential impacts of language on the quality of care provided.

Insurance-Related Disparities in Withdrawal of Life Support and Mortality After Spinal Cord Injury

Identifying disparities in health outcomes related to modifiable patient factors can improve patient care. To compare likelihood of withdrawal of life-supporting treatment (WLST) and mortality in patients with complete cervical spinal cord injury (SCI) with different types of insurance. This retrospective cohort study collected data between 2013 and 2020 from 498 trauma centers participating in the Trauma Quality Improvement Program. Participants included adult patients (older than 16 years) with complete cervical SCI. Data were analyzed from November 1, 2023, through May 18, 2024. Uninsured or public insurance compared with private insurance. Coprimary outcomes were WLST and mortality. The adjusted odds ratio (aOR) of each outcome was estimated using hierarchical logistic regression. Propensity score matching was used as an alternative analysis to compare public and privately insured patients. Process of care outcomes, including the occurrence of a hospital complication and length of stay, were compared between matched patients. The study included 8421 patients with complete cervical SCI treated across 498 trauma centers (mean [SD] age, 49.1 [20.2] years; 6742 male [80.1%]). Among the 3524 patients with private insurance, 503 had WLST (14.3%) and 756 died (21.5%). Among the 3957 patients with public insurance, 906 had WLST (22.2%) and 1209 died (30.6%). Among the 940 uninsured patients, 156 had WLST (16.6%) and 318 died (33.8%). A significant difference was found between uninsured and privately insured patients in the adjusted odds of WLST (aOR, 1.49; 95% CI, 1.11-2.01) and mortality (aOR, 1.98; 95% CI, 1.50-2.60). Similar results were found in subgroup analyses. Matched public compared with private insurance patients were found to have significantly greater odds of hospital complications (odds ratio, 1.27; 95% CI, 1.14-1.42) and longer hospital stay (mean difference 5.90 days; 95% CI, 4.64-7.20), which was redemonstrated on subgroup analyses. Health insurance type was associated with significant differences in the odds of WLST, mortality, hospital complications, and days in hospital among patients with complete cervical SCI in this study. Future work is needed to incorporate patient perspectives and identify strategies to close the quality gap for the large number of patients without private insurance.

Access to Sudden Hearing Loss Care at Urgent Care Centers.

To compare patient access to urgent care centers (UCCs) with a diagnosis of sudden hearing loss based on insurance. One hundred twenty-five random UCCs in states with Medicaid expansion and 125 random UCCs in states without Medicaid expansion were contacted by a research assistant posing as a family member seeking care on behalf of a patient with a one-week history of sudden, unilateral hearing loss. Each clinic was called once as a Medicaid patient and once as a private insurance (PI) patient for 500 total calls. Each phone encounter was evaluated for insurance acceptance and self-pay price. Secondary outcomes included other measures of timely/accessible care. Chi-square/McNemar's tests and independent/paired sample t-tests were performed to determine whether there were statistically significant differences between expansion status and insurance type. Calls ended before answering questions were not included in the analysis. Medicaid acceptance rate was significantly lower than PI (68.1% vs. 98.4%, p < 0.001). UCCs in Medicaid expansion states were significantly more likely to accept Medicaid (76.8% vs. 59.2%, p = 0.003). The mean wage-adjusted self-pay price was significantly greater in states with Medicaid expansion at $169.84 than in states without at $145.34 when called as a Medicaid patient (mean difference: $24.50, 95% Confidence Interval: $0.45-$48.54, p = 0.046). The rates of referral to an emergency department and self-pay price nondisclosure rates were greater for Medicaid calls than for private insurance calls (8.2% vs. 0.4% and 17.4% vs. 5.8%; p < 0.001 for both). Medicaid patients with otologic emergencies face reduced access to care at UCCs. NA Laryngoscope, 134:5066-5072, 2024.

Inequities in Alcohol Screening of Primary Care Patients with Chronic Conditions

Routine alcohol screening of people with chronic health conditions that are exacerbated by alcohol can help to prevent morbidity and mortality. The U.S. Affordable Care Act and other recent health reforms expanded insurance coverage and supported alcohol screening in primary care. This study assessed increases in alcohol screening following health reform and insurance-related and racial and ethnic disparities in screening. Data are from the 2013 to 2019 National Surveys on Drug Use and Health for adults with alcohol-related chronic conditions who received primary care in the past year (N=46,014). The outcome was receipt of alcohol screening (yes/no) in which a healthcare provider inquired whether, how often, or how much the respondent drank, or about having alcohol-related problems. Multivariable logistic regression models assessed temporal changes in screening overall and by insurance type and race/ethnicity, adjusting for demographics, health conditions, and primary care utilization. Statistical analysis was performed in 2023. Alcohol screening prevalence rose from 69% to 77% from 2013 through 2019, with a notable increase in 2014-2015 for both Medicaid-insured and privately-insured patients. Black and Asian American patients were generally less likely to be screened than White patients. Importantly, racial disparities in screening were found among privately-insured patients, patients with hypertension, patients with heart disease, and patients with diabetes who drink alcohol. Alcohol screening of primary care patients with chronic conditions increased following health reform, but persistent disparities among patients with private insurance and specific chronic conditions underscore the need to address drivers of unequal preventive care.

Socioeconomic disparities in survival outcomes of patients with NSCLC with brain metastases: A real-world analysis.

8569 Background: Racial and ethnic disparities have been previously reported in outcomes of metastatic cancer patients. While novel therapies have improved outcomes of NSCLC patients with brain metastases (BM), however, barriers to therapy persist, warranting updated evaluations of socioeconomic disparities in clinical outcomes. Methods: A retrospective cohort study was conducted on patients diagnosed with NSCLC BM in 2018-2020 in the National Cancer Database. Patients were classified as White, Black, American Indian, Aleutian or Pacific Islander (AAPI), or Asian. Sociodemographic and clinical outcomes were analyzed and reported using median overall survival (mOS) (95% CI). Multivariate analyses were performed using Cox proportional hazard models adjusting for sex, race, facility type, and income and reported using hazard ratios for death (HR) (95% CI). Results: 13850 patients with NSCLC BM were included: 81% (N=11123) were White, 14% (N=1914) Black, 0.5% (N=73) AAPI, 3.7% (N=508) Asian. 8% were treated in community cancer centers (CCC) and 39% in comprehensive CCCs (CCCC). 55% were Medicare-insured and 30% had annual income &gt;$74063. Compared to White, Asian patients had significantly better mOS of 29.1 months (24.57-36.5). Compared to non-Hispanic, Hispanic patients had significantly better mOS at 18.1 months (14.5-24.3). Medicaid and Medicare-insured had significantly worse outcomes vs. private-insured patients – mOS of 14.62 months (12.75-16.49) and 8.84 months (8.41-9.36) vs. 21.72 months (20.37-23.29). In multivariate analyses, compared to White, Asians had an HR of 0.61 (0.53-0.70). Hispanic had a HR of 0.77 (0.67-0.88) compared to non-Hispanic patients (P&lt;0.05). Compared to academic centers, patients treated at CCC (HR 1.42 (1.29-1.57)) and CCCC (HR 1.25 (1.19, 1.32)) had worse outcomes. Patients with higher annual income (&gt;$74063) had better outcomes compared to those with low income (&lt;$46277) (HR 0.83 (0.78-0.89), P&lt;0.002). Conclusions: Asian and Hispanic patients with NSCLC BM had better 3-year survival compared to White and non-Hispanic patients, respectively. Patients at community centers had worse outcomes than those at academic centers. Medicare-insured and Medicaid-insured patients had unfavorable outcomes. Targeted efforts are warranted to improve disparities in outcomes across racial and ethnic groups. [Table: see text]

Socioeconomic disparities in survival outcomes of patients with SCLC with brain metastases: A nationwide analysis.

e20133 Background: Despite advances in the management of cancer, socioeconomic disparities have been reported to impact survival outcomes. However, recent state of disparities in SCLC patients with brain metastases (BM) remains unknown. We explored socioeconomic disparities in survival outcomes of SCLC BM patients. Methods: We conducted a retrospective cohort study and included patients diagnosed with SCLC BM in 2018-2019 in the National Cancer Database. Patients were grouped as White, Black, American Indian, Aleutian or Pacific Islander (AAPI), or Asian. Socioeconomic and survival outcomes were analyzed and reported using median overall survival (mOS) (95% CI). Cox proportional hazard models adjusted for sex, race, facility type, education, and income and reported using hazard ratios for death (HR) (95% CI). Results: Of 2369 SCLC BM patients, 85% (N=2018) were White, 11% (N=259) Black, 0.4% (N=10), and 1.8% (N=43) Asian. 58% were Medicare-insured, and 21% earned &gt;$74,063. 40% were treated at comprehensive cancer care centers (CCC). Log-rank test revealed no significant difference in survival between races. Hispanic did not have a significant survival benefit compared to non-Hispanic patients. Medicare-insured patients have a significantly worse mOS of 7.56 months (6.90-8.28) compared to 13.77 months (12.62-16.07) in private-insured patients. Cox multivariate analysis (Table) showed improved survival in Asian (HR - 0.55, 0.34-0.89, P=0.014) and Black (HR- 0.82, 0.69-0.98, P=0.029) compared to White patients. Patients treated at CCCC had worse survival (HR-1.26, 1.11-1.42, P&lt;0.001) than in academic centers. Patients who earn more reported higher survival (HR-0.82, 0.68-0.98, P=0.030). Conclusions: Race did not significantly impact survival based on unadjusted analysis. Medicare-insured patients have unfavorable outcomes. On adjusted analysis, Asian and Black patients appear to have better survival. Treatment at community centers has worse survival. Focused efforts are warranted to bridge this gap and reduce disparities due to socioeconomic factors. [Table: see text]

Out-of-Pocket Expenditure for Selected Surgeries in the Cardiology Department for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), Private Health Insurance, and Uninsured Patients in a Tertiary Care Teaching Hospital in Karnataka, India.

Cardiovascular diseases are a major public health issue and the leading cause of mortality globally. The global economic burden of out-of-pocket expenditure (OOPE) for cardiovascular surgeries and procedures is substantial, with average costs being significantly higher than other treatments. This imposes a heavy economic burden. Government insurance schemes like Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) aim to enhance affordability and access to cardiac care. This retrospective study analyzed OOPE incurred for top cardiac surgeries under AB-PMJAY, private insurance, and uninsured patients at a tertiary care teaching hospital in Karnataka. Data of 1021 patients undergoing common cardiac procedures from January to July 2023 were analyzed using descriptive statistics (mean, median) and the Shapiro-Wilk test for normality. The study aims to evaluate financial risk protection offered by AB-PMJAY compared to private plans and inform effective policy-making in reducing the OOPE burden for surgeries in India. The study analyzed OOPE across 1021 patients undergoing any of four surgeries at a tertiary care teaching hospital in Karnataka. AB-PMJAY patients incurred zero OOPE across all surgeries. Uninsured patients faced the highest median OOPE, ranging from ₹1,15,292 (1390.57 USD) to ₹1,72,490 (2080.45 USD) depending on surgery type. Despite the presence of private insurance, the median out-of-pocket expenditure ranged from ₹1,689 (20.38 USD) to ₹68,788 (829.67 USD). Significant variations in OOPE were observed within different payment groups. Private insurance in comparison with AB-PMJAY had limitations like co-payments, deductibles, and limited coverage resulting in higher OOPE for patients. The results illustrate the efficacy of AB-PMJAY in reducing the financial burden and improving the affordability of cardiac procedures compared to private insurance. This emphasizes the significance of programmmes funded by the government in reducing the OOPE burden and ensuring equitable healthcare access. The comprehensive and particular estimates of OOPE for different surgical procedures, categorized by payment methods provide valuable information to guide the development of policies that aim to reduce OOPE and progress towarduniversal health coverage in India.

Abstract P156: Insurance Impact on Guideline-Directed Medical Therapy Prescription in HIV Heart Failure Patients: Past vs. Present Data From New York City's Largest Public Healthcare System

Introduction: Guideline-Directed Medical Therapy (GDMT), comprising renin-angiotensin system inhibitors, evidence-based β-blockers, mineralocorticoid inhibitors, and sodium glucose cotransporter 2 inhibitors, significantly enhances patient survival in heart failure cases. However, the impact of public insurance, private coverage, and being uninsured on GDMT for HIV heart failure patients is understudied. This research compares GDMT prescriptions across various insurance types over time. Method: This study analyzed data from the New York City Health + Hospitals HIV Heart Failure (NYC 4H) retrospective cohort, comprising records from eleven major NYC Health + Hospitals. Patients were recruited from hospital visits, both inpatient and clinic, spanning from July 2017 to June 2022. Follow-up records were reviewed between July 2022 and August 2023. Insurance types were determined based on primary insurance coverage in the medical charts. Guideline-directed medical therapy (GDMT) was reviewed at baseline and follow-up encounter. Insurance coverage and GDMT prescriptions were compared using chi-square tests. Multivariable logistic regression models, adjusted for age, sex, race, and co-morbidities, were employed to observe the association between insurance and GDMT prescriptions. Result: A total of 726 HIV heart failure patients participated in the study, including 263 with Medicare, 334 with Medicaid, 96 with private insurance, and 33 without insurance. Significant difference in GDMT prescriptions were evident at baseline, with &gt;1 and &gt;2 GDMT prescriptions being higher among uninsured (69.7% and 36.4%) and Medicare (66.2% and 37.6%) patients compared to Medicaid (54.8% and 29.9%) and private insurance patients (55.2% and 20.8%) (P&lt;0.05). Private insurance holders exhibited a 49% lower likelihood of receiving &gt;2 GDMT prescriptions than Medicare beneficiaries after adjusting for age, sex, race, and co-morbidities (adjusted odds ratio [aOR] 0.51, 95% confidence interval [CI] [0.28, 0.93], p&lt;0.05). Over the four-year follow-up, prescription rates for GDMT medications notably increased. However, disparities persisted in &gt;1 and &gt;2 GDMT prescriptions across insurance types, including 90.9% and 51.5% for uninsured, 76% and 48.3% for Medicare, 72.8% and 45.2% for Medicaid, and the lowest rates of 66.7% and 35.4% for private insurance patients, respectively (P&lt;0.05). After adjusting for covariates, no statistically significant differences in GDMT prescriptions were found across insurance type. Conclusion: GDMT prescriptions significantly improved over the follow-up period within HIV heart failure population. Although the differences diminished slightly, private insurance beneficiaries consistently exhibited the lowest GDMT prescription rates at both baseline and follow-up, in comparison to Medicare, Medicaid, and the uninsured population.

Epidemiology of Irritable Bowel Syndrome in a Large Academic Safety-Net Hospital.

(1) Background: Irritable bowel syndrome (IBS) is a highly prevalent disorder of gut-brain interaction (DGBI) that is known to reduce the quality of life and raise healthcare costs. The aim of this study was to describe the epidemiology of IBS in a large multiracial academic safety-net hospital. (2) Methods: An electronic query was performed using ICD-9 codes to identify 740 IBS outpatients seen at the Boston Medical Center (BMC) between 1 January 2005 and 30 September 2007. Demographic data were collected from electronic medical records. Bivariate analyses using chi-square tests and ANOVA were used to calculate the significance of categorical and continuous dependent variables, respectively. (3) Results: Compared with the general BMC outpatient population, the IBS cohort consisted of significantly higher proportions of White and Asian patients and lower proportions of Black and Hispanic patients (p < 0.0001). White and Asian patients predominantly had private insurance, while Black and Hispanic patients mostly had government/state-funded or no insurance (p < 0.0001). The IBS subgroup frequencies were similar across racial groups; however, Hispanic patients had IBS with constipation (32%, p < 0.02) more often compared to non-Hispanic patients. (4) Conclusions: Significant differences were found across the racial groups studied in this large outpatient IBS cohort. These findings are likely attributed to racial and socioeconomic disparities in healthcare access and utilization.

Impact of Palliative Care Utilization among Kidney Cancer Patients in US Hospitals: A National-Scale Analysis

The objective of this study was to examine the characteristics and utilization patterns of palliative care among the kidney cancer patients using a large-scale representative population-based sample. We retrospectively analyzed National Inpatient Sample hospitalization data from January 2020 to December 2020 to explore disparities in delivering palliative care to deceased kidney cancer patients and assess its impact on healthcare usage, focusing on hospital costs and length of stay (LoS). We used ICD-10 CM codes (International Classification of Diseases-classifying diagnoses and reasons for visits in all healthcare settings) to categorize the study population. We conducted univariable and multivariable linear and logistic regression analyses to calculate coefficients and odds ratios, considering relevant variables and addressing potential confounding factors. We studied 1437 deceased kidney cancer patients, with 53.9% receiving palliative care. Those receiving palliative care had lower total costs ($99,804 vs. $1,34,731) and a shorter LoS (7.19 days vs. 7.66 days), compared to those who didn’t. No significant difference was discovered in LoS. Private insurance, higher income, and female patients were more likely to receive palliative care. Race, hospital teaching status, and hospital size showed no significant differences. This study revealed insights into palliative care use among deceased kidney cancer patients, with cost-saving benefits evident. Disparities showed that individuals with private insurance and higher income more likely accessed palliative care, and females received it more often than males. Physicians and policymakers must consider these findings for equitable resource allocation and improved access.

Scoping Review of Healthcare Disparities in Treatment of Craniosynostosis: Assessing Impacts of Race, Insurance, and Socioeconomic Status

Background: Racial and socioeconomic factors persist as barriers to timely diagnosis and treatment for children with craniosynostosis, contributing to inequitable care. This scoping review aims to better understand how disparities influence differences in services, approach, and outcomes for patients undergoing surgical corrections for craniosynostosis. Methods: We conducted a PRISMA systematic review of all articles published between 2003 and 2023 within PubMed/Medline, Embase, and a Scopus cited review. Variables of interest included sociodemographic factors such as race, socioeconomic status (SES), and insurance status, and measurements of treatment access or outcomes within craniosynostosis surgical repair. Results: The final analysis included 28 studies, of which 21 studies examined race, 13 examined insurance status, and 5 examined household income or other socioeconomic factors. Overall, non-White, minority patients, patients with Medicaid or government-funded insurance, and patients from lower SES were more likely to experience delays in diagnosis and presentation for surgery compared to White and privately-insured patients. Black and Hispanic patients and patients with public insurance were more likely to undergo open cranial vault reconstruction (CVR) at an older age and experience longer total surgery time, increasing perioperative complication risk, compared to patients who underwent endoscopic procedures. Sociodemographic factors including non-White race, lower SES, and being underinsured or uninsured predisposed patients to the more expensive CVR procedure, increased hospital length of stay (LOS), and a higher rate of readmission, accumulating to greater total cost of care. Conclusion: Significant disparities continue to exist in craniosynostosis management. It is still unknown whether these discrepancies in the type of operation lead to significant clinical differences in neurocognitive outcomes, revision operations, or patient/parent satisfaction with appearance. This study highlights gaps in the current body of knowledge to better inform future aeas of investigation to ensure the best outcomes for all children born with craniosynostosis regardless of patient demographic.

Delay in prior authorization of biologic therapy: Another possible cause of healthcare disparity in IBD patients

Biologics, a mainstay in inflammatory bowel disease (IBD) treatment, typically require prior authorization from insurance companies. Multiple studies show that African Americans are less likely to be prescribed biologics. The prior authorization process may perpetuate disparities in healthcare. This study evaluated the approval time for biologics in IBD. A chart review of IBD patients seen in a university gastroenterology clinic over 5 years was performed. Patient gender, race, IBD subtype, biologic use, and insurance type were recorded. Insurance type was classified as private or public (Medicaid or Medicare). Biologic agents evaluated included infliximab, adalimumab, vedolizumab and ustekinumab. Length of time to approval (TTA) and length of time to first infusion or administration (TFI) were recorded. Analysis was performed using t-testing, Fisher's exact testing, and ANOVA with significance set at p<0.05. The study was IRB approved. 458 charts were analyzed. 66 patients were being treated with a biologic. 42 had private insurance, 16 Medicaid and 8 Medicare. 37 patients had ulcerative colitis, 27 Crohn's disease, and 2 indeterminate colitis. There were 38 men and 28 women. 32 patients were white, 26 African American, 1 Asian, 5 other, and 2 declined identification. Average TTA was 30.5 days (range 1-145) and average TFI was 45.3 days (range 2-166). African Americans were more often on public insurance compared to whites (p=0.0001). Crohn's disease compared to ulcerative colitis patients were more often on public insurance (p=0.017). Significantly more private compared to public insurance patients were on infliximab (p=0.001). Medicaid and Medicare patients had significantly longer mean TTAs than private insurance patients (49.1 and 52.7 vs 19.4 days, p=0.007). African Americans had significantly longer mean TTA compared to whites (45.9 vs 24.8 days, p=0.044). Crohn's disease compared to ulcerative colitis patients had significantly longer mean TTA (39.7 vs 21.8 days, p=0.050). This study shows that prior authorization for biologic therapy was longer for African Americans. Patients on public insurance also tend to have a longer TTA, and more African Americans were on public insurance compared to White patients in this study which may explain the difference in biologic access for African Americans.