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.

Keywords: Medicaid; chronic low back pain; commercial private insurance; socioeconomic status; Health care utilization.

背景：患者的社会经济地位较低以及就医机会有限被认为是慢性下背痛相关残疾增加的潜在原因。

目的：这项研究旨在通过比较参加医疗补助计划和私人保险患者的医疗保健利用情况，探讨来自社会经济背景较差的慢性下背痛患者在医疗服务方面的使用情况。

设计：回顾性研究。

地点：一家单中心学术医院健康系统。

方法：本研究审查了2019年至2023年间由4名物理医学专家诊治的所有以慢性下背痛为主要诊断、年龄在22至60岁之间的患者病历，并收集了几项医疗保健使用数据。

结果：研究共纳入了424名患者，其中206名（49%）患者参加了医疗补助计划，218名（51%）患者拥有私人保险。在医疗保险组中，参加物理治疗的次数比私保组多（平均：7.1次，中位数：2次 vs 平均：5.2次，中位数：0次，P

局限性：这项回顾性的性质及样本量较小限制了观察变量间因果关系的确立。此外，由于私人保险患者可能去外部的私人诊所就诊管理慢性下背痛，因此本研究中私立保险患者的医疗保健使用情况可能会被低估。

结论：这项研究表明，参加医疗补助计划的患者在某种程度上甚至更多地利用了医疗服务。此外，在医疗保险组中也观察到了较高的缺席率。

关键词：医疗补助；慢性下背痛；商业私人保险；社会经济地位；医疗保健使用。