Document Detail

Time to pediatric epilepsy surgery is longer and developmental outcomes lower for government compared with private insurance.
MedLine Citation:
PMID:  23615092     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: It is unclear if socioeconomic factors like type of insurance influence time to referral and developmental outcomes for pediatric patients undergoing epilepsy surgery.
OBJECTIVE: This study determined whether private compared with state government insurance was associated with shorter intervals of seizure onset to surgery and better developmental quotients for pediatric patients undergoing epilepsy surgery.
METHODS: A consecutive cohort (n = 420) of pediatric patients undergoing epilepsy surgery were retrospectively categorized into those with Medicaid (California Children's Services; n = 91) or private (Preferred Provider Organization, Health Maintenance Organization, Indemnity; n = 329) insurance. Intervals from seizure onset to referral and surgery and Vineland developmental assessments were compared by insurance type with the use of log-rank tests.
RESULTS: Compared with private insurance, children with Medicaid had longer intervals from seizure onset to referral for evaluation (log-rank test, P = .034), and from seizure onset to surgery (P = .017). In a subset (25%) that had Vineland assessments, children with Medicaid compared with private insurance had lower Vineland scores presurgery (P = .042) and postsurgery (P = .003). Type of insurance was not associated with seizure severity, types of operations, etiology, postsurgical seizure-free outcomes, and complication rate.
CONCLUSION: Compared with Medicaid, children with private insurance had shorter intervals from seizure onset to referral and to epilepsy surgery, and this was associated with lower Vineland scores before surgery. These findings may reflect delayed access for uninsured children who eventually obtained state insurance. Reasons for the delay and whether longer intervals before epilepsy surgery affect long-term cognitive and developmental outcomes warrant further prospective investigations.
Jason S Hauptman; Andrew Dadour; Taemin Oh; Christine B Baca; Barbara G Vickrey; Stefanie Vassar; Raman Sankar; Noriko Salamon; Harry V Vinters; Gary W Mathern
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurosurgery     Volume:  73     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-06-20     Completed Date:  2014-01-24     Revised Date:  2014-04-08    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  152-7     Citation Subset:  IM    
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MeSH Terms
California / epidemiology
Child, Preschool
Epilepsy / epidemiology*,  surgery*
Infant, Newborn
Managed Care Programs / utilization*
Medicaid / utilization*
Private Sector
Referral and Consultation / utilization*
Retrospective Studies
Socioeconomic Factors
Treatment Outcome
United States / epidemiology
Waiting Lists*
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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