Nav: Home

Brain tumor patients fare better with private insurance, new study finds

March 03, 2015

GAINESVILLE, Fla. -- Brain tumor patients who are uninsured or use Medicaid stay hospitalized longer and develop more medical complications than those with private insurance, University of Florida Health researchers have found.

The uninsured and Medicaid patients were also at greater risk of developing a new medical condition in the hospital and 25 percent more likely to die during their stay, according to a study published online Feb. 18 in the journal Neurosurgery. Those same patients ended up in a nursing home, rehabilitation center or hospice more frequently than people who had private insurance. For the study, the researchers analyzed nationwide data from 566,346 hospital admissions involving brain tumor cases between 2002 and 2011.

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, said Kristopher G. Hooten, M.D., a resident in the UF College of Medicine's department of neurosurgery and the study's lead author.

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

"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," he said.

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.

"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," Hooten said.

Once hospitalized, patients with private insurance and those on Medicaid also fared differently, the study found. The Medicaid patients were 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 were 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, Hooten said, the Medicaid patients are more likely to have a broader set of medical problems.

All of those factors contribute to longer hospital stays, a higher death rate and a greater likelihood that Medicaid recipients and the uninsured will end up in a nursing home, rehabilitation center or hospice rather than going home, the study found. After adjusting for all of the hospital and patient factors, the outcomes and occurrence in hospital-acquired conditions were similar. However, Medicaid and uninsured patients still had an unexplained longer length of stay, which may be a direct result of their insurance status.

Researchers hope their findings will be used in several ways. Those include helping patients by identifying conditions like obesity and poor nutrition that put them at greater risk for other medical problems.

The findings also show how a federal agency's current method of comparing hospitals' quality could benefit from more precise information about patient populations. Hospitals that care for higher-risk Medicaid and uninsured patients should be judged differently than those that have more privately insured patients, said Maryam Rahman, M.D., an assistant professor in the UF department of neurosurgery and the senior author of the study. 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 said.

Data used by the UF Health researchers came 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, Rahman said.

Hooten and Rahman hope that the findings will be used to affect health care policy and improve disparities in medical care.

"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," Rahman said.

University of Florida

Related Health Care Articles:

Care management program reduced health care costs in Partners Pioneer ACO
Pesearchers at Partners HealthCare published a study showing that Partners Pioneer ACO not only reduces spending growth, but does this by reducing avoidable hospitalizations for patients with elevated but modifiable risks.
Health care leaders predict patients will lose under President Trump's health care plans
According to a newly released NEJM Catalyst Insights Report, health care executives and industry insiders expect patients -- more than any other stakeholder -- to be the big losers of any comprehensive health care plan from the Trump administration.
The Lancet: The weaponisation of health care: Using people's need for health care as a weapon of war over six years of Syrian conflict
Marking six years since the start of the Syrian conflict (15 March), a study in The Lancet provides new estimates for the number of medical personnel killed: 814 from March 2011 to February 2017.
In the January Health Affairs: Brazil's primary health care expansion
The January issue of Health Affairs includes a study that explores a much-discussed issue in global health: the role of governance in improving health, which is widely recognized as necessary but is difficult to tie to actual outcomes.
Advocacy and community health care models complement research and clinical care
Global lung cancer researchers and patient advocates today emphasized that new models of delivering care and communicating about cancer care play an important role in the fight against lung cancer.
About 1 million Texans gained health care coverage due to Affordable Care Act
Texas has experienced a roughly 6 percentage-point increase in health insurance coverage from the Affordable Care Act, according to new research by experts at Rice University and the Episcopal Health Foundation.
In India, training informal health-care providers improved quality of care
Training informal health-care providers in India improved the quality of health care they offered to patients in rural regions, a new study reports.
Affordable Care Act has improved access to health care, but disparities persist
The Affordable Care Act has substantially decreased the number of uninsured Americans and improved access to health care, though insurance affordability and disparities by geography, race/ethnicity, and income persist.
Integrated team-based care shows potential for improving health care quality, use and costs
Among adults enrolled in an integrated health care system, receipt of primary care at integrated team-based care practices compared with traditional practice management practices was associated with higher rates of some measures of quality of care, lower rates for some measures of acute care utilization, and lower actual payments received by the delivery system, according to a study appearing in the Aug.
Study finds quality of care in VA health care system compares well to other settings
The quality of health care provided to US military veterans in Veterans Affairs (VA) facilities compares favorably with the treatment and services delivered outside the VA.

Related Health Care Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#532 A Class Conversation
This week we take a look at the sociology of class. What factors create and impact class? How do we try and study it? How does class play out differently in different countries like the US and the UK? How does it impact the political system? We talk with Daniel Laurison, Assistant Professor of Sociology at Swarthmore College and coauthor of the book "The Class Ceiling: Why it Pays to be Privileged", about class and its impacts on people and our systems.