Access to spine care for the poor and near poor

Background context: Access to care for poor/near poor patients is a concerning and growing problem within the American system of medical care. Purpose: The objective of this study was to examine the relationship between health insurance status and access to spine care among patients below 65 years of age eventually receiving treatment at our tertiary academic medical center. Study design: Descriptive study based on chart review and telephone interviews. Patient sample: Two groups of 64 patients each with surgical pathology of limited complexity and limited comorbidities, one with Medicaid insurance and one with private, commercial insurance. Outcome measures: Reasons for referral, travel distance, travel time, frequency of visits, and proximity of fellowship-trained spinal surgeons. Methods: Two groups, each with 64 consecutive spine surgical patients, were studied and compared. Group One had "Medicaid" coverage and Group Two was privately insured. All patients (both groups) were treated surgically for similar pathology of limited complexity and had limited comorbdities. They were assessed to determine the difficulties they encountered in receiving care before referral to our medical center including factors such as referral by a local provider based on insurance status alone and travel time/distance/frequency to eventually receive care at our center. The availability of local care for these patients (fellowship-trained spine surgeons in their local area) was also assessed. Results: The great majority (78%) of poor/near poor patients with Medicaid coverage from counties at some distance from (and local to) our center were referred/deferred on the basis of insurance status alone given surgical problems which could have comfortably been addressed by orthopedic surgeons, neurosurgeons, or fellowship-trained spine surgeons local to the patient. This difficulty in access to care results in a significant burden (measured in time/travel/costs) for these patients. Conclusions: The poor/near poor with Medicaid insurance have less access to local spine care than those with private, commercial health insurance. The implications (from both surgeon and patient perspectives) of this dilemma are discussed.