Patients with brain tumors fare better with private insurance

Brain tumor patients who are uninsured or use Medicaid stay hospitalized longer and develop more medical complications than those with private insurance, according to a new study published in Neurosurgery (2015; 76(3):239-348).

The uninsured and Medicaid patients were also at greater risk of developing a new medical condition in the hospital and 25% more likely to die during their stay. 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 University of Florida (UF) Health researchers in Gainesville 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, MD, 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 do not 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 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 is not 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.

The findings 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 senior author Maryam Rahman, MD, an assistant professor in the UF Department of Neurosurgery. Some hospitals might publicize a negligible complication rate for a certain condition, but that alone does not tell the whole story.

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