Disparities in access but not outcomes: Medicaid versus non-Medicaid patients in multidisciplinary chronic pain rehabilitation.
Taylor B Crouch, Sharlene Wedin, Rebecca Kilpatrick and 5 others
PMID 38411127WHAT IT FOUND
Medicaid patients started pain rehab with worse pain and lower function than non-Medicaid patients, but both groups improved equally over three weeks.
Access to multidisciplinary programs remains the barrier, not the effectiveness of the treatment for disadvantaged populations.
Key findings
01Medicaid participants had higher baseline pain severity and poorer physical functioning than non-Medicaid participants.
02Both Medicaid and non-Medicaid groups showed statistically significant improvements across all treatment outcomes from pre- to post-treatment.
03There was no significant difference in the rate of improvement between Medicaid and non-Medicaid patients across any outcome measure.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was conducted at a single centre in South Carolina, a Medicaid non-expansion state, so results may not apply to other regions or healthcare systems. The non-Medicaid group was heterogeneous, including both private and federal insurance types, making it difficult to isolate the specific impact of Medicaid versus other coverage. Income data was not collected, so the study could not control for socioeconomic factors beyond insurance status. There was no long-term follow-up, so it is unknown if the improvements lasted after the 3-week program ended. The study did not control for race, acknowledging that racial disparities are intertwined with Medicaid disparities, which may confound the interpretation of insurance status alone.
Declared interests
The research was supported by the National Institute on Drug Abuse (NIDA) and the Medical University of South Carolina Center for Opioid Research and Education. The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that Medicaid patients have worse outcomes overall. They started with worse baseline function but improved just as much as non-Medicaid patients. The disparity is in access to the program, not in the biological or psychological response to the treatment.