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Time to Pediatric Epilepsy Surgery Is Longer and Developmental Outcomes Lower for Government Compared With Private Insurance

Hauptman, Jason S. MD, PhD*; Dadour, Andrew BS*; Oh, Taemin BA*; Baca, Christine B. MD, MSHS‡,§; Vickrey, Barbara G. MD, MPH‡,§; Vassar, Stefanie MS‡,§; Sankar, Raman MD, PhD‡,¶,‖; Salamon, Noriko MD#; Vinters, Harry V. MD‡,**; Mathern, Gary W. MD*,‡‡

doi: 10.1227/01.neu.0000429849.99330.6e
Research-Human-Clinical Studies

BACKGROUND: It is unclear if socioeconomic factors like type of insurance influence time to referral and developmental outcomes for pediatric patients undergoing epilepsy surgery.

OBJECTIVE: This study determined whether private compared with state government insurance was associated with shorter intervals of seizure onset to surgery and better developmental quotients for pediatric patients undergoing epilepsy surgery.

METHODS: A consecutive cohort (n = 420) of pediatric patients undergoing epilepsy surgery were retrospectively categorized into those with Medicaid (California Children's Services; n = 91) or private (Preferred Provider Organization, Health Maintenance Organization, Indemnity; n = 329) insurance. Intervals from seizure onset to referral and surgery and Vineland developmental assessments were compared by insurance type with the use of log-rank tests.

RESULTS: Compared with private insurance, children with Medicaid had longer intervals from seizure onset to referral for evaluation (log-rank test, P = .034), and from seizure onset to surgery (P = .017). In a subset (25%) that had Vineland assessments, children with Medicaid compared with private insurance had lower Vineland scores presurgery (P = .042) and postsurgery (P = .003). Type of insurance was not associated with seizure severity, types of operations, etiology, postsurgical seizure-free outcomes, and complication rate.

CONCLUSION: Compared with Medicaid, children with private insurance had shorter intervals from seizure onset to referral and to epilepsy surgery, and this was associated with lower Vineland scores before surgery. These findings may reflect delayed access for uninsured children who eventually obtained state insurance. Reasons for the delay and whether longer intervals before epilepsy surgery affect long-term cognitive and developmental outcomes warrant further prospective investigations.

ABBREVIATIONS: CCS, California Children's Services

DQ, developmental quotient

HIPAA, Health Insurance Portability and Accountability Act

HMO, Health Maintenance Organization

PPO, Preferred Provider Organization

UCLA, University of California, Los Angeles

*Department of Neurosurgery, Mattel Children's Hospital, David Geffen School of Medicine, University of California, Los Angeles, California;

Department of Neurology, Mattel Children's Hospital, David Geffen School of Medicine, University of California, Los Angeles, California;

§Department of Neurology, VA Greater Los Angeles Health Care System, Los Angeles, California;

Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine, University of California, Los Angeles, California;

Division of Pediatric Neurology, Mattel Children's Hospital, David Geffen School of Medicine, University of California, Los Angeles, California;

#Division of Neuroradiology, Mattel Children's Hospital, David Geffen School of Medicine, University of California, Los Angeles, California;

**Section of Neuropathology, Mattel Children's Hospital, David Geffen School of Medicine, University of California, Los Angeles, California;

‡‡Department of Psychiatry & Biobehavioral Medicine, Mattel Children's Hospital, David Geffen School of Medicine, University of California, Los Angeles, California

Correspondence: Gary W. Mathern, MD, 710 Westwood Plaza, Room 2123 Los Angeles, CA 90095-1769. E-mail: gmathern@ucla.edu

Received July 5, 2012

Accepted March 19, 2013

Copyright © by the Congress of Neurological Surgeons