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Patients with epilepsy in the United States (US) face a health care system that is as diverse as the regions and population of the country. Regional patterns of referral and standards of care intermingle with systems of paying for services and are influenced by the medico-legal experiences within regions or states. Thus, the treatment of patients with epilepsy is influenced as much by health insurance systems as it is by the availability of neurologists. Whereas medical, social, and economic factors influence the delivery of care for US patients with epilepsy, other factors including training, experience, and interest in epilepsy on the part of the primary care physician also play a role.
The health care system in the US is in a state of flux. Policy changes have been driven by the need to manage costs. Although this means deep cuts have been made to government programs, these policies have also resulted in a shift of dollars away from health care providers to the investors in for-profit health care companies.1 The increases in profits for investors come at the expense of patients with diseases who are in need of care. For-profit control of health care is a default phenomenon that is apparently beyond the courage of the government to change, and is causing perturbations in the fabric of care that are not likely to serve the good of any patient with a chronic illness.2 This is especially true for the patient with epilepsy. In the US, the financial resources of the patient determine access to care for epilepsy as well as influence the quality of care. Although a patient's fluency in English and educational and social background affect where treatment will be delivered, the single most important factor in how care will be provided is the patient's payment resource. …
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