Where Do Most Brain Tumor Patients Without Insurance or of Low Socioeconomic Status Receive Care: A Comparison of Academic vs Non-Academic Centers

Introduction: This study evaluates brain tumor treatment in the New York metropolitan area, focusing on where uninsured or low socioeconomic status (SES) patients predominantly receive care by comparing academic versus non-academic centers. The primary aim is to highlight cost-related disparities and the influence of institutional type on care accessibility for this patient population.

Methods: Data from 2010-2021 was obtained from the Statewide Planning and Research Cooperative System (SPARCS) of New York State. Brain tumor patient data was queried using relevant ICD, CPT, and HCPS codes to form a cohort (n=4529). Univariate analysis of demographic, SES, and cost variables followed by a mixed model regression was utilized to identify factors influencing cost and hospital type.

Results: There were 48% females in the cohort. Insurance coverage comprised private (35%), public (9.7%), multiple-payor (52%), and other (3.2%). Patients identified as Black (9.3%), White (58%), Asian (6%), multiracial (1.2%), and other races (26%). Discharge year, pre-and post-operative duration, and facility type significantly predicted charge variations (p < 0.001). Annual charges increased over time (p < 0.001), and non-academic institutions incurred lower charges than their academic counterparts (p < 0.001). Race and multi-payer status also influenced cost, with “Other” selected-racial category (p < 0.001) and multi-payor coverage (p < 0.001) being notable predictors of higher and lower total charges, respectively. The mixed-effects model accounted for the inter-institutional variability and demonstrated a robust fit (marginal R² = 0.728, conditional R² = 0.826), underscoring the multifactorial nature of healthcare costs.

Conclusion : The study reveals that in a setting of increasing costs over time and disparities across racial and insurance domains, non-academic centers provide more cost-effective brain tumor care. The results highlight a need for targeted interventions for equitable healthcare access and reimbursement policies.