Medical Student UConn School of Medicine Farmington, Connecticut, United States
Introduction: The expansion of Medicaid eligibility, made possible by the Affordable Care Act (ACA) in 2010, has increased patient access to primary and preventive care. Current literature shows that within subspecialty fields, such as neurosurgery, there has not been an observed increase in access for those insured by Medicaid. Despite the expansion of Medicaid coverage in 38 states who adopted the ACA, disparities in healthcare accessibility remain. This study evaluates access to treatment for spinal conditions for patients covered by Medicaid in United States academic neurosurgery departments.
Methods: Academic neurosurgery departments were identified from the AANS residency program list. The affiliated neurosurgery clinics were contacted via phone numbers available on institution websites. The calls were made portraying a fictitious patient in need of a neurosurgical spine consult. Phone conversations were conducted using a standard question tree. Questions assessed whether clinics accept Medicaid patients and if care is provided by trainees (e.g., residents and fellows) or faculty. Results were compared between institutions in Medicaid expansion states versus institutions in non-expansion states.
Results: 28 institutions were contacted. Data was collected for 17, of which 11 were in Medicaid expansion states. The acceptance rates of Medicaid patients for institutions in expansion and non-expansion states was 90.9% and 83.3%, respectively. Of the institutions in expansion states, 50% stated that Medicaid patients are seen by faculty or trainees depending on availability, whereas 50% stated they are seen by faculty only. Of institutions in non-expansion states, 80% stated that Medicaid patients are seen by faculty or trainees, whereas 20% stated they are seen by faculty only.
Conclusion : A phone survey of 17 academic neurosurgery departments suggests patient access and access to faculty for Medicaid patients seeking a spine surgery evaluation may differ between institutions in Medicaid expanded versus non-expanded states.
How to Improve Patient Care: It is important to conduct this research that may shed light on a potential gap in neurosurgical care as disparities are known to affect patient outcomes in all branches of medicine. Better understanding of the disparities in spine care can help guide clinical and public health efforts to improve outcomes for disadvantaged and underrepresented patients.
