Evolution of Healthcare Access for Brain Tumor Patients over a Decade

Introduction: By comparing neurosurgical care access over a decade, this study examines whether healthcare policy changes facilitated improved availability and timeliness of care for brain tumor patients. The study aims to analyze the effectiveness of public insurance expansion in reducing healthcare access disparities among brain tumor patients in New York State (NYS).

Methods: Statewide Planning and Research Cooperative System (SPARCS) of NYS provided access to data from 2010-2021. Brain tumor patient data was queried using relevant ICD, CPT, and HCPS codes to form a cohort (n=4529). Patients were further classified into two sub-cohorts based on the timepoint of Medicaid expansion under the Affordable Care Act (ACA) in 2014. Univariate analysis of demographic and healthcare access variables followed by a mixed model regression was utilized to identify factors contributing to neurosurgical care access.

Results: There were 48% females in the cohort. Patients identified as Black (9.3%), White (58%), Asian (6%), multiracial (1.2%), and other races (26%). After 2014, there was a significant increase in patients covered under Medicaid (OR= 1.48, p< 0.001), namely those who self-identified as Black (OR= 2.96, p< 0.001) and other race (OR= 2.81, p< 0.001). The expansion of Medicaid under the ACA significantly increased ED admission (OR= 1.32, p< 0.001) and care in non-academic centers (OR= 3.08, p< 0.001). Patients with an extended stay length were linked with medicare coverage (OR= 1.03, p< 0.001).

Conclusion : The study findings indicate that a notable shift in public insurance coverage led to increased access to brain tumor care at non-academic centers and promoted Medicaid enrollment among Black and other racial groups. The increase in emergency admissions underscores the impact of healthcare policy changes and the need for interventions that optimize healthcare utilization.