Disparities in Access to Spinal Surgery Based on Insurance Type Among Elderly Patients

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Geriatric Medicine

Background:

• Spinal surgeries are increasingly common in the aging US Medicare population.
• Utilization and costs of core spine procedures have risen significantly.
• Barriers to care may increase complications for publicly insured patients.

Purpose of the Study:

• To examine access to spinal surgery for Medicare Advantage (MA) plans versus private insurance and Traditional Medicare (TM).
• To identify trends in spinal surgery accessibility for the elderly population.

Main Methods:

• Cross-sectional study of Florida spine surgeons using the "secret shopper" technique.
• Researchers posed as elderly patients seeking spinal fusion to assess insurance acceptance and appointment availability.
• Evaluated Traditional Medicare, Blue Cross Blue Shield, and two Medicare Advantage plans.

Main Results:

• Only 47-49% of eligible surgeons accepted two MA plans, compared to 74% (BCBS) and 85% (TM).
• MA plans were accepted at significantly lower rates than TM and BCBS (p < 0.01).
• No significant difference in appointment availability was found based on insurance type (p = 0.575).

Conclusions:

• Patients with MA plans have significantly reduced access to spine surgeons in Florida compared to TM and private insurance.
• This study indicates a potential disadvantage for patients with MA plans regarding access to care.
• Further research is needed to understand the implications and financial impacts of these accessibility variations.