You were just diagnosed with a neurological disorder, what’s next? Of course it depends on what disorder exactly, but more often than not these diagnoses are accompanied with a discussion about a prognosis, or long-term timeline of that disorder. Along with that, the healthcare professional will most likely detail a schedule of follow ups and possible treatment options to either treat the symptoms or ease a patient as best as they can into the end stage of the disorder. This aspect of healthcare is crucial because when creating these timelines, medical professionals are trying to think of the best way to keep a person out of the emergency room and hospital. Ultimately, hoping to keep the person comfortable and not accruing too much debt in medical expenses. Unfortunately this goal is not often met throughout the entire population, as this part of healthcare is riddled with racial and socioeconomic inequalities.
One large scale study of about 279,103 respondents, looked at three groups in terms of the disparities in access and utilization of neurological health care: Non-Hispanic white, Non-Hispanic black, and Hispanic people. The data showed that black participants were nearly 30% and Hispanic participants nearly 40% less likely to see an outpatient neurologist when compared to the whtie participants. Additionally, this study also found that Non-Hispanic black participants had the highest # of encounters for a neurological diagnosis in terms of Emergency department visits and Hospital inpatient discharges. Leading to an overall per capita cost of care of about 1,485$, which is almost triple the per capita cost for Non-Hispanic white and Hispanic participants. The study goes on to discuss how these racial/ethnic disparities are multifactorial. Two of which can be a distrust in the healthcare system or a low density of neurologists in necessary locations. For example, California has less than half the number of neurologists per 100,000 residents than Massachusetts, despite being more racially and ethnically diverse. (Saadi, 2017).
The socioeconomic disparity is quite clear on what exactly causes it and it boils down to costs. This may seem like an obvious statement, and you would think that programs such as Medicaid (state/federal program which provides health coverage for low income individuals) and Medicare (federal program which provides health coverage to 65+ year olds or 65 and under individuals with a disability) exist so why is there much of a disparity? In the outpatient setting, practices are not forced to take patients who are on these health care coverage plans. According to MACPAC, about 71% of providers took Medicaid and 85% took Medicare. This is in comparison to about 90% of providers accepting private insurance (Masterson, 2019). Well, this shouldn’t really make that much of a difference, right? The percentage is not 0, so there has to be some provider relatively close to people who will take their insurance, right? One study showed that 1 in every 11 insured adults either delayed medical care or did not seek medical care in 2020 due to costs which include copays and travel (Ortaliza, 2022). This mindset of “someone will take care of this patient” is counterintuitive to what healthcare is supposed to be and continues to push away whole populations of people.
In spite of the cause of the disparity in access and utilization of neurological healthcare, there should not be any reason for the healthcare system to fall into the same trap as other institutions which are too afraid to change and hide behind a veil of “where do we even begin”. I believe two major aspects that lend to such disparities discussed previously, is that the emergency room is 24/7 and cannot deny a patient any services. This is an issue, not only within the neurological side of medicine, but in all fields. Outpatient hours are not really conducive to people who also work a 9-5, nor are they inclined to accept medicaid. As the insurance side of this problem has been a battle for many years, the extended outpatient hours is a much more feasible goal. Some offices do have late night hours, but these offices are few and far between meaning if such an office is too far out of the way for a patient, they might feel more inclined to go to the emergency room. The main way I could see more practices including late night hours, would be to entice them with tax breaks or other benefits.
Saadi, A., Himmelstein, D. U., Woolhandler, S., & Mejia, N. I. (2017). Racial disparities in neurologic health care access and utilization in the United States. Neurology, 88(24), 2268–2275. https://doi.org/10.1212/wnl.0000000000004025
Masterson, L. (2019, January 28). Doctors less likely to accept Medicaid than other insurance. Healthcare Dive. https://www.healthcaredive.com/news/doctors-less-likely-to-accept-medicaid-than-other-insurance/546941/
Ortaliza, J., Fox, L. How does cost affect access to care? (2022, January 14). Peterson-KFF Health System Tracker. https://www.healthsystemtracker.org/chart-collection/cost-affect-access-care/