Abstracts

Rationale: Current literature clearly demonstrates the existence of global health disparities regarding access to epilepsy care. In Puerto Rico, there is only one Epilepsy Monitoring Unit (EMU) funded in 2009 and serving a total population of approximately 3.7 million people. Health care delivery system in Puerto Rico is constituted mainly by 2 systems, private health insurance and the public Medicaid Health Reform, with an approximately distribution in the population of 36% and 38%, respectively. Prior health insurance authorization, as requested by an epileptologist, is required for inpatient continuous video EEG monitoring. Our EMU accepts all health insurances; therefore, it has widespread availability across the entire population. The principal aim of our study is to compare the time for epilepsy monitoring unit admission approval between the private health insurance patients and the public health reform patients.Methods: A retrospective data review was performed of all admissions to the Epilepsy Monitoring Unit since 2009. Data was subdivided into two subgroups based on the type of health insurance, including private health insurance patients and public health reform patients. For the time period between January 1, 2013 and May 31, 2013, data was collected regarding the date preauthorization submission for inpatient video EEG monitoring and the date approval. Using this data, the mean time for EMU admission approval was calculated for each of the groups.Results: Total number of admissions to the Epilepsy Monitoring Unit since 2009 has been 786, with 80.4% constituting the private insurance patients group, 12.3% the public health reform group and 7.3% other type of payments including medicare. In the period between January 1, 2013 and May 31, 2013, the mean time for EMU admission approval was 7.6 days for the private health insurance group versus 68.4 days for the public health reform group.Conclusions: Our data demonstrates that there is a significant health disparity in the treatment of epilepsy between patients with private insurance and those with Medicaid in Puerto Rico. There is significant delay in epilepsy monitoring unit admission approval in the health reform group of up to two months. When compared to private health insurance the delay in approval in the health reform/Medicaid group is nine times more. In addition those with Medicaid have limited access to an epileptologist since each of the four epileptologist only have one half-day epilepsy clinic per week for Medicaid patients. Further research will be performed to understand other specific factors that may increase health disparities in epilepsy. The identification of these factors should lead to the development of public health policies that minimize disparity.