Impact of insurance status on migraine care in the United States

Wilper, Andrew P.; Woolhandler, Steffie; Himmelstein, David U.; Nardin, Rachel

doi:10.1212/wnl.0b013e3181d8fff4

Cited by 31 publications

(30 citation statements)

References 20 publications

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“…EHR databases-such as the one being built and maintained by OCHIN-will be key to the study of how health reform policies implemented under the Patient Protection and Affordable Care Act of 2010 (PPACA) affect the uninsured and underinsured. [41][42][43][44][45][46][47][48][49] Although some states are putting considerable resources toward building all-payer claims databases to better address the PPA-CA's evaluation requirements, 50 such databases will not include uninsured and transiently insured populations. Information from EHR data will be more accurate than administrative claims data; thus, it is imperative to further develop and validate important EHR data resources and to evaluate the extent to which EHR data can be used to supplement (or substitute for) claims data.…”

Section: Research and Policy Implicationsmentioning

confidence: 99%

Electronic Health Records vs Medicaid Claims: Completeness of Diabetes Preventive Care Data in Community Health Centers

DeVoe

Gold

McIntire

et al. 2011

The Annals of Family Medicine

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PURPOSE Electronic Health Record (EHR) databases in community health centers (CHCs) present new opportunities for quality improvement, comparative effectiveness, and health policy research. We aimed (1) to create individual-level linkages between EHR data from a network of CHCs and Medicaid claims from 2005 through 2007; (2) to examine congruence between these data sources; and (3) to identify sociodemographic characteristics associated with documentation of services in one data set vs the other. METHODSWe studied receipt of preventive services among established diabetic patients in 50 Oregon CHCs who had ever been enrolled in Medicaid (N = 2,103). We determined which services were documented in EHR data vs in Medicaid claims data, and we described the sociodemographic characteristics associated with these documentation patterns. RESULTSIn 2007, the following services were documented in Medicaid claims but not the EHR: 11.6% of total cholesterol screenings received, 7.0% of total infl uenza vaccinations, 10.5% of nephropathy screenings, and 8.8% of tests for glycated hemoglobin (HbA 1c ). In contrast, the following services were documented in the EHR but not in Medicaid claims: 49.3% of cholesterol screenings, 50.4% of infl uenza vaccinations, 50.1% of nephropathy screenings, and 48.4% of HbA 1c tests. Patients who were older, male, Spanish-speaking, above the federal poverty level, or who had discontinuous insurance were more likely to have services documented in the EHR but not in the Medicaid claims data.CONCLUSIONS Networked EHRs provide new opportunities for obtaining more comprehensive data regarding health services received, especially among populations who are discontinuously insured. Relying solely on Medicaid claims data is likely to substantially underestimate the quality of care.

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Section: Research and Policy Implicationsmentioning

confidence: 99%

Electronic Health Records vs Medicaid Claims: Completeness of Diabetes Preventive Care Data in Community Health Centers

DeVoe

Gold

McIntire

et al. 2011

The Annals of Family Medicine

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“…7 Medicaid patients were less likely than privately insured patients to receive abortive (OR 1.6, 95% CI 1.1-2.3) and prophylactic therapy (OR 1.5, 95% CI 1.0-2.1) for migraine headaches in a national study of more than 68 million visits for migraine. 6 By contrast, a study of the Medical Expenditure Panel Survey using the National Health Interview Survey found people with epilepsy had similar medical resource utilization but lower out-of-pocket costs for antiepileptic drugs compared to those with private insurance. 23 Poststroke care may also differ between Medicaid and privately insured neurologic patients.…”

Section: Discussionmentioning

confidence: 95%

Neurologic disorders in Medicaid vs privately insured children and working-age adults

et al. 2014

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SummaryThis retrospective, observational study reports health utilization and access patterns of Medicaid recipients for neurologic diseases compared to privately insured individuals seen in 2 hospitals at a single institution in the same time period. We reviewed records of patients and compared demographic characteristics, visit types, neurologic diagnoses, and all-cause mortality, by age group, when seen with Medicaid vs private insurance. Adults insured by Medicaid were more likely to present as inpatients and with life-threatening neurologic disease compared to privately insured patients. Moreover, adult patients presenting with neurologic disease on Medicaid had a higher all-cause mortality rate than privately insured patients. Similar disparities in neurologic disease were not observed in children. The relationship of these findings to patient educational status, household income, comorbidities, and the reasons prompting Medicaid eligibility require additional study. N early 60 million Americans are insured by Medicaid, the nation's largest health insurance program for people of limited income.1 Covered groups include children, pregnant women, and individuals with disabilities. More than one-third of all births and more than one-half of people with AIDS in the United States are covered by Medicaid.

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“…There are several challenges to headache care among those on Medicaid, underinsured, or uninsured. One study, which analyzed 11 years of data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1997 to 2007, showed that the uninsured and those with Medicaid receive substandard therapy for migraine, at least in part because they received less care in physicians’ offices and more care in EDs . Transportation to specialized headache care centers poses a problem as headache clinics are few, and in some states headache specialty centers do not exist .…”

Section: Introductionmentioning

confidence: 99%

“…One study, which analyzed 11 years of data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1997 to 2007, showed that the uninsured and those with Medicaid receive substandard therapy for migraine, at least in part because they received less care in physicians' offices and more care in EDs. 22 Transportation to specialized headache care centers poses a problem as headache clinics are few, and in some states headache specialty centers do not exist. 23 Individuals with lower incomes may not have the time, financial, social, or other resources for coordinated headache care, especially if it includes long-distance travel or an inpatient headache stay (childrearing, work loss, etc).…”

Section: Introductionmentioning

confidence: 99%

Migraine Care Challenges and Strategies in US Uninsured and Underinsured Adults: A Narrative Review, Part 1

et al. 2018

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Impact of insurance status on migraine care in the United States

Abstract: The uninsured, and those with Medicaid, receive substandard therapy for migraine, at least in part because they receive more care in emergency departments and less in physicians' offices.

Cited by 31 publications

References 20 publications

Electronic Health Records vs Medicaid Claims: Completeness of Diabetes Preventive Care Data in Community Health Centers

Electronic Health Records vs Medicaid Claims: Completeness of Diabetes Preventive Care Data in Community Health Centers

Neurologic disorders in Medicaid vs privately insured children and working-age adults

Migraine Care Challenges and Strategies in US Uninsured and Underinsured Adults: A Narrative Review, Part 1

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