Importance of Telehealth in Neurosurgical Care - Geographical and Socioeconomic Analysis of US Counties Based on Where They Receive Neurosurgical Care

Introduction: Neurosurgeons are unevenly dispersed across the United States (US). This can require patients to travel across state lines, to receive necessary neurosurgical care. Allowing telehealth across state lines during the COVID-19 public health emergency has likely increased access to neurosurgical care. We aimed to identify and evaluate which US counties have their closest neurosurgeon across state lines.

Methods: United States Federal Information Processing System (FIPS) codes were utilized to correlate every US county to its nearest corresponding county with neurosurgical care available. We can determine if both counties are in the same state by analyzing the first 2 digits in each county’s unique FIPS code. Counties with the closest neurosurgeon across state lines were compared to those that did not cross state lines.

Sub-analysis was performed excluding states that allow licensing reciprocity as of April 2023.

Results: Of 3140 US counties, 2707 have their nearest neurosurgical care in their home state (in-state), while 433 US counties have their closest neurosurgeon across state lines (out-of-state). In-state vs. out-of-state counties had a mean income of 50387 vs. 45818 USD (p < 0.0001).

In a sub-analysis of 958 counties with no licensing reciprocity, 831 counties have their nearest neurosurgical care in their home state, and 127 must cross state lines. In-state vs. out-of-state counties had a mean income of 52332 vs. 43003 USD (p < 0.0001).

Conclusion : On average, patients residing in counties with their nearest neurosurgeon across state lines have a lower income than counties with their closest neurosurgeon in the same state. If neurosurgical care is needed, this places an increased financial burden on a population with fewer economic resources. This highlights telehealth's utility for initial consultation and follow-up to minimize travel costs.