Insurance-associated variance in rehabilitation utilization after initial malignant primary brain tumor resection

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Abstract Background Rehabilitation interventions aid functional impairments in patients with malignant primary brain tumors (MPBTs). Socioeconomic factors can influence their care; therefore, this study compares the rehabilitation and healthcare utilization within 12 months of surgical resection of MPBTs between patients with commercial or Medicaid insurance. Methods Adult cases (ages 18-65) of MPBTs were extracted from the Merative MarketScan database (2000-2022) and classified according to the type of insurance (commercial or Medicaid) at the time of surgery. Overall rehabilitation utilization and type of rehabilitation were compared. Healthcare utilization was evaluated at discharge from index surgery hospitalization and at 12 months post-discharge. Generalized linear regression models were used for analysis. Results Patients with MPBT formed study groups of commercial (n = 12 504) and Medicaid (n = 1875) insurance. Both groups had similar overall rehabilitation utilization 12 months after surgical tumor resection. However, patients with Medicaid had significantly higher utilization of home health, skilled nursing facilities, and inpatient rehabilitation facilities, and patients with commercial insurance had higher outpatient rehabilitation utilization. Index surgery hospitalization was longer for patients with Medicaid. At 12 months post-discharge, patients with Medicaid had significantly greater healthcare utilization, including emergency room visits (65.60% vs. 49.60%; q < .0002), hospital admissions (40.60% vs. 36.30%; q = .0011), and medication refills (34 vs. 32; q = .0002). Conclusion Patients with MPBTs utilize types of rehabilitation differently depending on insurance coverage. Patients with Medicaid insurance had greater healthcare utilization. Further research on actionable changes that can reduce these possible disparities is needed.

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