The impact of insurance disparities on long-term burn outcomes: A Burn Model System investigation

Introduction: Access to healthcare and insurance coverage are associated with quality of life, morbidity, and mortality outcomes. However, most studies have only focused on same-admission and short-term outcomes due to the lack of national longitudinal datalthere are limited data on this topic in the burn literature. Our aim was to determine the effect of insurance status on long-term outcomes in a national sample of burn patients.

Methods: This retrospective study used the longitudinal Burn Model System National Database from January 1997 to December 2020. The inclusion criteria were all adult patients admitted for burn injury from participating sites. Main outcomes were the physical (PCS) and mental (MCS) health component summary scores of the Veterans RAND 12 (VR-12) score at 6, 12, and 24 months after injury. Adjusting for demographic and clinical characteristics, multivariable regression was used to examine the association between insurance status and the outcomes.

Results: A total of 1809 burn patients were included. Most patients had private/commercial insurance (60.42 %), followed by Medicare (13.99 %) and Medicaid (12.77 %). The remaining 13 % were uninsured patients (self-pay or philanthropy). In adjusted analyses, Medicaid insurance was associated with worse MCS at 6 months (Coefficient -4.24, 95 % CI -6.06 - -2.41) and 12 months (Coefficient -3.62, 95 % CI -5.68 - -1.57), and worse PCS at all timepoints, compared to private/commercial insurance. Medicare insurance was associated with worse MCS scores at 12 months (Coefficient -2.86, 95 % CI -5.06 - -0.66) and worse PCS scores at all timepoints.

Conclusion: Having Medicaid and Medicare insurance was significantly associated with a lower health-related quality of life at long-term follow up, even after adjusting for demographics and burn injury severity.