Medical Student Touro University California Union City, California, United States
Introduction: With an average lifetime direct cost between 1.1 to 4.7 million dollars, SCI is one of the costliest and incapacitating neurologic conditions. This study examines whether patients suffering from SCI who are of lower socioeconomic status tend to have worse functional outcomes.
Methods: In this study, the Transforming Research and Clinical Knowledge in SCI (TRACK-SCI) registry was queried to identify patients who had a primary payor of either private insurance (PI) or Medicaid. Demographic, clinical, imaging and outcome data were collected.
Results: N = 83 patients with either Medicaid or PI were enrolled from 2014 – 2022. 33 patients (36.26%) had PI while 50 patients (54.95%) had Medicaid. Medicaid patients differed significantly from PI patients in terms of race (P < 0.001), family income (P < 0.001), years of education (P < 0.001), and occupation (P=0.007). More PI patients underwent SCI surgery compared to Medicaid patients (94% vs 78%, P=0.039). Discharge location type also differed significantly from both groups (P=0.001), with most PI patients discharged to acute rehabilitation (48%) and most Medicaid patients being discharged to skilled nursing facilities/group living (40%). There were no differences between the two groups regarding lower extremity motor scores and total motor scores over time (at day 0, day 7, 6 months, and 12 months from time of SCI).
Conclusion : PI patients tend to be discharged to acute rehabilitation facilities while Medicaid patients tend to be discharged to skilled nursing facilities/group living after SCI. These differences reflect a lack of access to post-acute rehabilitation for Medicaid patients. However, our study shows no differences in motor scores between the two groups at 0 days, 7 days, 6 months, and 12 months from time of SCI. This suggests that although Medicaid and PI patients may have differing access to post-acute care, overall functional outcomes may not be different between the two groups.