TUESDAY, July 20 (HealthDay News) -- Children with Medicaid coverage have the same odds of receiving an initial cochlear implant as those with private insurance, but are less likely to receive a sequential bilateral implant, and they have higher complication rates and worse follow-up compliance, according to research published in the July issue of the Archives of Otolaryngology -- Head & Neck Surgery.
To determine if socioeconomic status influences access to cochlear implantation in an environment of adequate Medicaid reimbursement, David T. Chang, Ph.D., of the Case Western Reserve University School of Medicine in Cleveland, and colleagues conducted a retrospective cohort study of 133 pediatric patients -- 64 Medicaid insured and 69 privately insured -- referred for cochlear implantation.
The researchers found no significant difference in the odds of having a cochlear implant performed between the Medicaid group and the private insurance group of children. There were also no significant differences in age at referral or age at implantation. However, prelingual children in the Medicaid group had significantly decreased odds of having a bilateral, sequential cochlear implant (odds ratio, 0.43), and had nearly five-fold greater odds of having an implantation-related complication (odds ratio, 4.6). Children with Medicaid were also less compliant with follow-up office visits than privately insured children (missed 35 percent of appointments versus 23 percent), and missed more consecutive visits (1.9 versus 1.1).
"Despite equal access among Medicaid-insured and privately insured patients, there seem to be important differences between the groups post-implantation that influence outcome, namely, decreased follow-up compliance, increased incidence of minor and major complications, and decreased rates of sequential bilateral implantation. Taken together, these results indicate that centers should further investigate opportunities to minimize these downstream disparities," the authors write.
One of the authors is a member of the Surgeon's Advisory Board of Cochlear Corp.; Cochlear Corp. provided Medicaid reimbursement data for the study.
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