1. 2025;28;E271-E280Health Care Utilization for Chronic Low Back Pain Among Medicaid Patients Versus Privately Insured Patients – A Retrospective Study
   Retrospective Study
   Robin Raju, DO, Jesse Reynolds, MS, Jiani Zhu, BS, Sergio Uriel Mosquera Limas, DO, and Whinkie Leung, MS.

BACKGROUND: Poor socioeconomic status and low access to care among patients have been identified as potential reasons for increased in disability associated with chronic low back pain.

OBJECTIVES: This study aims to explore health care utilization by patients who have chronic low back pain and come from poor socioeconomic backgrounds by comparing Medicaid patients to privately insured patients.

STUDY DESIGN: Retrospective study.

SETTING: A single-center academic hospital health system.

METHODS: This study reviewed the charts of all patients who had primary diagnoses of low back pain, were between the ages of 22 and 60 years old, and had been seen by 4 physiatrists from 2019 to 2023. Several health care utilization data were collected.

RESULTS: Of the 424 patients, 206 (49%) patients had Medicaid insurance, and 218 (51%) patients had private insurance. Individuals in the Medicaid group attended more physical therapy sessions (mean: 7.1, median: 2) than did those with private insurance (mean: 5.2, median: 0, P < 0.001). With respect to “no-show” appointments, the Medicaid group (mean: 8.6, median: 4) had a significantly higher number of missed appointments than did the private group (mean: 3.0, median: 1, P < 0.001). Further regression analyses showed that patients in the Medicaid group with high Charlson Comorbidity Index scores had statistically significant high no-show counts (P < 0.0001). The median number of behavioral health sessions was significantly higher in the Medicaid group (mean: 6.8, median: 4) than in the private group (mean: 5.6, median: 3, P = 0.030). The number of Physical Medicine & Rehabilitation sessions, magnetic resonance images, spine injections, and spine surgeries performed during the study period were similar for both groups.

LIMITATIONS: The retrospective nature of the study and small sample size limit the ability to establish causation among observed variables. The health care utilization of privately insured patients as compared to Medicaid patients could have been underreported in this study, since the former could have gone to outside private practices for the management of low back pain.

CONCLUSIONS: This study showed that Medicaid patients utilized health care to a similar if not greater extent than did privately insured patients. In addition, there was also a high “no-show” count in the Medicaid group.

KEY WORDS: Health care utilization, socioeconomic status, chronic low back pain, Medicaid, commercial private insurance