Health insurance and transportation barriers impact access to epilepsy care in the United States

• Published in: Epilepsy research Vol. 205; p. 107424
• Main Authors: Kamitaki, Brad K., Maniar, Shelly, Rambhatla, Raaga, Gao, Kelly, Cantor, Joel C., Choi, Hyunmi, Bover Manderski, Michelle T.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2024
• Subjects: Adolescent; Adult; Aged; Cross-Sectional Studies; Driving; Epilepsy - economics; Epilepsy - therapy; Female; Health Services Accessibility - statistics & numerical data; Health services research; Humans; Insurance Coverage - statistics & numerical data; Insurance, Health - statistics & numerical data; Male; Middle Aged; Motor vehicle; Neurological care; Retrospective Studies; Seizure; Transportation; United States; Young Adult; United States; Driving; Motor vehicle; Seizure; Neurological care; Health services research
• ISSN: 0920-1211; 1872-6844; 1872-6844
• DOI: 10.1016/j.eplepsyres.2024.107424

Inconsistent access to healthcare for people with epilepsy results in reduced adherence to antiseizure medications, increased seizure frequency, and fewer appropriate referrals for epilepsy surgery. Identifying and addressing factors that impede access to care should consequently improve patient outcomes. We hypothesized that health insurance and transportation affect access to outpatient neurology care for adults living with epilepsy in the United States (US). We conducted a retrospective cross-sectional study of US adults with active epilepsy surveyed via the National Health Interview Survey (NHIS) in 2015 and 2017. We established whether patients reported seeing a neurologist in the past year and used multiple logistic regression to determine whether health insurance status and transportation access were associated with this outcome. We identified 735 respondents from 2015 and 2017, representing an estimated 2.98 million US adults with active epilepsy. After adjusting for socioeconomic and seizure-related co-variates, we found that a lack of health insurance coverage was associated with no epilepsy care in the past year (adjusted odds ratio [aOR] 0.22; 95 % confidence interval [CI]: 0.09 – 0.54). Delayed care due to inadequate transportation (aOR 0.42; 95 % CI: 0.19 – 0.93) also resulted in reduced patient access to a neurologist. Due to the inherent nature of their condition, people with epilepsy are less likely to have employer-sponsored health insurance or consistent driving privileges. Yet, these factors also impact patient access to neurological care. We must address transportation and insurance barriers through long-term investment and partnership between community, healthcare, and government stakeholders. •64.8 % of US adults with active epilepsy saw a neurologist in 2015 and 2017.•Patients without insurance were less likely to see a neurologist.•Transportation barriers also contribute to decreased access to epilepsy care.