Abstracts

RATIONALE: The funding sources for treatment for epilepsy is considered important in order for physicians and hospitals to be paid, but knowledge of funding source may also provide an index of other factors relevant to patient care. The objective of this study is to determine if funding source provides a basic index of mental abilities and psychosocial functioning in patients with epilepsy .
METHODS: A total of 85 adults admitted for long term EEG monitoring were the subjects of the study. Each was evaluated by type of funding source. It was found that 52 patients were funded by Medicaid, Medicare based upon disability, or a combination of each, and that 33 patients were funded by non-welfare related commercial insurance plans. Intelligence was evaluated by means of the Wechsler Adult Intelligence Scale--III (WAIS--III), and psychosocial adjustment by the Washington Psychosocial Seizure Inventory (WPSI).
RESULTS: The WAIS-III VIQ was significantly (p = .002) lower for the welfare (M 85.71, SD 12.08) than the insurance covered group (M 95.30, SD 13.81). The same pattern was found for the PIQ (p =.042; welfare group: M 87.94, SD 12.35; insurance group: M 94.06, SD 13.75) and for the FSIQ (p =.004; welfare group: M 85.54, SD 12.10; insurance group: M 94.36, SD 13.86. With regard to psychosocial adjustment, no differences were found on the validity (Lie, Rare Items) scales of the WPSI. However, statistically significant differences were found on seven of eight WPSI clinical scales with the results always showing fewer problems with the insurance covered group than the welfare group: Emotional Adjustment (p = .019); Interpersonal Adjustment (p = .003); Vocational Adjustment (p = .001); Financial Status (p = .004); Adjustment to Seizures (p= .008); Medicine and Medical Management (p= .045); Overall Psychosocial Functioning (p= .001). While the substantial differences found in the vocational and financial areas were expected, of considerable interest is the fact that emotional and interpersonal adjustment were significantly worse with welfare funded patients than with insured patients. In addition, patients on welfare perceived their seizures to be more disabling than insured patients, and they also tended to take a dimmer view of the advice offered by physicians than insured individuals. Another strong finding was that only the Family Background scale failed to show a difference between the welfare and insured patients, which argues against families of origin being blamed for the other differences between the welfare and insured groups.
CONCLUSIONS: Patients who are funded by Medicaid, or disability-related Medicare, have diminished intelligence in comparison with patients covered by health insurance, and especially so in verbal skills which includes their ability to present themselves orally. In addition, these same patients show significantly greater psychosocial concerns than patients covered by health insurance that is not welfare based, and these concerns are broader than merely being out of work or momentarily short of funds. This study shows that the type of funding a patient has can be an index to help the provider assess a patient[ssquote]s adjustive resources and perhaps also the amount (and cost) of care that will be required.