Does Insurance Status Impact Delivery of Care with Upper Airway Stimulation for OSA?

Patel, Jena; Topf, Michael C.; Huntley, Colin; Boon, Maurits

doi:10.1177/0003489419878454

Cited by 7 publications

(4 citation statements)

References 23 publications

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“…The impact of insurance type on delay to surgical care has been shown for various otolaryngologic surgeries, including upper airway stimulation, 13 adenotonsillectomy, 6 auditory brainstem response testing, 14 cochlear implantation, 15 and head and neck cancer treatment, 16 with publicly insured patients demonstrating higher rates of delay. Patients in our study who were insured by Medicaid at the time of their clinic visits had 40% higher odds of rescheduling the surgery than privately insured patients.…”

Section: Insurance-related Factorsmentioning

confidence: 99%

Relationship between Insurance Type and Delays in Tympanostomy Tube Placement

Schwartz

Shah

Wetzel

2020

Ann Otol Rhinol Laryngol

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Objective: To investigate the role of insurance carriers and changes in insurance on rates of cancelation and rescheduling of tympanostomy tube surgery. Methods: Retrospective cohort study between January 1, 2013 and December 31, 2018 at a single tertiary care academic pediatric otolaryngology practice of pediatric patients (≤18 years) who underwent tympanostomy tube placement for any indication. Patients had to have insurance providers recorded both at clinic visit and at the time of surgery. Rates of cancelation and postponement of tympanostomy tube placement were assessed. Logistic regression was performed to determine factors associated with cancelation or postponement of surgery. Results: Of the 5080 patients, 2961 patients had Medicaid and 2012 patients had private insurance at the time of surgery. A total of 197 (3.96%) patients switched insurance between clinic appointment and date of surgery. Time to surgery was nearly 2 weeks more for those who had a change in insurance vs. those who did not (33 vs. 20 days, P < .001). Those who switched insurance were nearly twice as likely to have to reschedule surgery than those who did not (OR 1.95, CI 1.42-2.67). Patients who had Medicaid as the primary payer also had increased odds of needing to reschedule and postpone surgery (OR 1.39, 95% CI 1.17-1.63). Conclusion: Difference in insurance carrier and loss/change of insurance appear to be associated with delays in tympanostomy tube placement. Standardization of re-enrollment schedules across insurance providers or a single payer model may be useful in addressing these delays in care.

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Section: Insurance-related Factorsmentioning

confidence: 99%

Relationship between Insurance Type and Delays in Tympanostomy Tube Placement

Schwartz

Shah

Wetzel

2020

Ann Otol Rhinol Laryngol

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“…Some factors resulting in patients not receiving timely diagnosis and treatment have been shown, such as imperfect sleep monitoring equipment, a lack of multidisciplinary sleep diagnosis centers, fewer sleep monitoring beds per capita, and complex medical procedures in hospitals with inconvenient emergency room green paths, a longer waiting time for examination, and insufficient understanding of the OSA for some medical staff [15][16][17][18]. The medical treatment behavior of OSA patients would have been affected by country medical insurance policies, reimbursement modes and proportions of provinces and cities, and coverage of private medical insurance [18][19][20][21][22][23]. For example, the government fully bears the treatment cost of OSA in France, while it only partially reimburses the surgical treatment cost of OSA in China.…”

Section: Time Elapsed Before Diagnosed and Determining Factorsmentioning

confidence: 99%

Influencing factors of delay in seeking medical attention of patients with obstructive sleep apnea based on the Model of Pathways to Treatment in China: a qualitative analysis

Shang,

Chen,

Deng

et al. 2024

Sleep Breath

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Background There is the highest estimated number of patients with obstructive sleep apnea (OSA) in China. Early treatment could lead to fewer complications associated with OSA. This study aimed to analyze the factors influencing help-seeking from the first symptom discovery to treatment in OSA. Methods Semi-structured interview outline was designed to conduct face-to-face interview based on the analyses of a great number of related literatures on the delay in seeking medical attention of patients with OSA. 15 patients diagnosed were interviewed between June 2021 to September 2022 in general hospital of Shenyang, Northeastern of China. Qualitative data was analyzed by content analysis using the Model of Pathways to Treatment. Results Analyses identified factors contributing to elapsed time from first symptom discovery to received treatment that are linked to disease characteristic, patients, health system organization. Appraisal interval is most obvious for patients with OSA, but it is difficult to pinpoint precisely because the patients didn’t remember exactly when the first symptom was detected. Conclusions Patients diagnosed with OSA didn’t initially interpret the snore as a warning sign and even thought it was a blessing. The findings provided guidance or avenues for reducing elapsed time between the first symptom and received treatment.

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“…23,25 Studies from the United States also noted shorter waiting periods for upper airway stimulation among Medicare patients compared with privately insured patients. 32 However, insurance denials were more prevalent among certain demographic groups such as females and Medicare patients or those with previous use of oral appliances, impacting treatment decisions. 32,33 Institutional factors also were noted to influence treatment decisions.…”

Section: Sociodemographic Factorsmentioning

confidence: 99%

“…32 However, insurance denials were more prevalent among certain demographic groups such as females and Medicare patients or those with previous use of oral appliances, impacting treatment decisions. 32,33 Institutional factors also were noted to influence treatment decisions. For instance, patients diagnosed at US hospitals serving lower income and uninsured patients had reduced referral rate for oral appliance therapy evaluation and were more likely to be lost for follow-up.…”

Section: Sociodemographic Factorsmentioning

confidence: 99%

Sociodemographic and Healthcare System Barriers to PAP Alternatives for Adult OSA: A Scoping Review

Singh,

Bhat,

Saroya

et al. 2024

The Laryngoscope

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ObjectiveTo investigate sociodemographic and healthcare system barriers to access and utilization of alternative treatments to positive airway pressure (PAP) in the management of adult obstructive sleep apnea (OSA).Data SourcesPubMed, Embase, and Web of Science databases were searched from 2003 to 2023 for English‐language studies containing original data on sociodemographic and healthcare system barriers to PAP‐alternative treatments for adult OSA.Review MethodsStudies were assessed using the Preferred Reporting Items for Systematic Reviews and Meta‐analyses Extension for Scoping Reviews (PRISMA‐ScR) guidelines. Title and abstract screening, full‐text review, and data collection were conducted by two investigators independently.ResultsOut of 1,615 studies screened, 13 studies met inclusion criteria and reported on a total of 1,206,115 patients who received PAP alternative treatments, including surgery (n = 9 studies), and oral appliances (OAs) (n = 3 studies). The chance of receiving a PAP‐alternative treatment such as surgery was greater among patients aged 39 years or younger, had body mass index below 30 kg/m2, fewer comorbidities, private insurance, and a higher occupational and income status. The decision of individuals to receive PAP alternative treatments was influenced by increased patient education from providers, as well as improvements in daytime sleepiness and partner perception of snoring and apnea.ConclusionCumulative evidence suggests that several sociodemographic and healthcare system factors are associated with decreased use of PAP alternatives when PAP therapy fails. Investigation of interventions to eliminate these potential barriers may improve access and treatment outcomes. Laryngoscope, 2024

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Does Insurance Status Impact Delivery of Care with Upper Airway Stimulation for OSA?

Cited by 7 publications

References 23 publications

Relationship between Insurance Type and Delays in Tympanostomy Tube Placement

Relationship between Insurance Type and Delays in Tympanostomy Tube Placement

Influencing factors of delay in seeking medical attention of patients with obstructive sleep apnea based on the Model of Pathways to Treatment in China: a qualitative analysis

Sociodemographic and Healthcare System Barriers to PAP Alternatives for Adult OSA: A Scoping Review

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