Pan I-Wen, Lam Sandi, Clarke Dave Fitzgerald, Shih Ya-Chen Tina
Baylor College of Medicine, Department of Neurosurgery, 7200 Cambridge St, Houston, TX 77030, United States of America; Texas Children's Hospital, Department of Neurosurgery, 6701 Fannin St, Houston, TX 77030, United States of America.
Baylor College of Medicine, Department of Pediatrics, Neurology and Developmental Neuroscience Section, 6701 Fannin St, Houston, TX 77030, United States of America; Texas Children's Hospital, Department of Neurology, Epilepsy Center, 6701 Fannin St, Houston, TX 77030, United States of America.
Epilepsy Behav. 2018 Dec;89:48-54. doi: 10.1016/j.yebeh.2018.09.042. Epub 2018 Oct 26.
The objective of the study is to investigate the association between insurance transitions and healthcare utilization among children with refractory epilepsy.
We applied published algorithms to identify the study cohort of children with a diagnosis of refractory epilepsy who were treated between 10/1/2013 and 9/30/2014 at 36 children's hospitals in the United States. Insurance transition was defined as having any change in the type of primary payer from the first date of diagnosis to the date of the last visit at the same hospital. Univariate and multilevel multivariable analytical methods were used in the study.
Among 3488 children hospitalized with refractory epilepsy, rates of insurance transitions at 1, 2, and 5 years of refractory epilepsy diagnosis were 8.1%, 14%, and 29.9%, respectively. Patients whose primary payer at diagnosis was Private or Others were more likely to experience insurance transitions than patients whose primary payer was Medicaid. Younger children were associated with a higher risk of insurance transitions than older children. The high intensity of insurance transitions was associated with a higher number of emergency department and inpatient visits.
Insurance transitions interrupted the continuity of medical care for children with refractory epilepsy and were associated with more frequent hospitalizations and emergency department visits, which then translated to higher healthcare costs. Medicaid provided stable insurance coverage and is critically important for these patients and should be the main focus for policies aiming to minimize insurance transitions and optimize healthcare delivery.
本研究的目的是调查难治性癫痫患儿保险转换与医疗服务利用之间的关联。
我们应用已发表的算法，确定2013年10月1日至2014年9月30日期间在美国36家儿童医院接受治疗的诊断为难治性癫痫的患儿研究队列。保险转换定义为从诊断的第一天到在同一家医院最后一次就诊日期，主要支付方类型发生任何变化。本研究采用单变量和多水平多变量分析方法。
在3488名因难治性癫痫住院的儿童中，难治性癫痫诊断后1年、2年和5年的保险转换率分别为8.1%、14%和29.9%。诊断时主要支付方为私人或其他类型的患者比主要支付方为医疗补助的患者更有可能经历保险转换。年龄较小的儿童比年龄较大的儿童保险转换风险更高。保险转换的高强度与急诊科就诊和住院次数较多相关。
保险转换中断了难治性癫痫患儿的医疗连续性，并与更频繁的住院和急诊科就诊相关，进而导致更高的医疗成本。医疗补助提供了稳定的保险覆盖，对这些患者至关重要，应成为旨在尽量减少保险转换和优化医疗服务提供的政策的主要重点。
