Comparison of Patient Insurance Status and Case Severity for Neurosurgery Patients in Public and Private Hospitals in New York City

Introduction: Neurosurgery services are provided at many tertiary care centers in New York City (NYC) and are split between private and public hospitals. While both hospital categories are available to treat patients, the patient population and pathology distribution likely vary based on the hospital type. Using a New York state database, the Statewide Planning and Research Cooperative System (SPARCS), our study investigates the distribution of patients and pathologies through the lens of hospital type to better understand how care is distributed.

Methods: Inpatient discharges for neurosurgical pathologies from 2009-2021 were aggregated for seven hospitals (four private and three public institutions) in NYC to establish public and private hospital cohorts. All patients met the following criteria: within the SPARCS database, affiliated with 1+ neurosurgical pathologies as determined by APR-DRG codes, treated at seven selected NYC hospitals, and discharged from 2009-2021. This provided a sample of 170,905 patients. Statistical analyses (Z-tests) were performed in Python.

Results: Four private and three public hospitals in NYC were included in the study. When comparing the two groups, private hospitals had a significantly higher proportion of privately to publicly insured patients compared to public hospitals (0.431 vs 0.134, p < 0.001). In addition, private hospitals had a higher elective to non-elective ratio compared to public hospitals (0.544 vs 0.059, p < 0.001). Lastly, private hospitals had a lower high-severity to low-severity ratio compared to public hospitals (0.30 vs 0.35, p < 0.001).

Conclusion : Public and private hospitals treat different populations and pathologies within neurosurgery. Public hospitals exhibit a higher rate of non-elective procedures, treat more severe pathologies, and treat a greater proportion of patients with public insurance. These findings indicate the need to further analyze patient accessibility to neurosurgical care at private hospitals and the resources necessary to support neurosurgical practices within public hospitals.