scholarly journals Does the insurance status influence in-hospital outcome? A retrospective assessment in 30,175 surgical trauma patients in Switzerland

2021 ◽  
Author(s):  
Lukas Funke ◽  
Claudio Canal ◽  
Franziska Ziegenhain ◽  
Hans-Christoph Pape ◽  
Valentin Neuhaus
Keyword(s):  
Exclusion Criterion ◽  
Surgical Trauma ◽  
Insurance Status ◽  
Trauma Patients ◽  
Complication Rates ◽  
Physical Status ◽  
Public Insurance ◽  
National Quality ◽  
Publicly Insured ◽  
Insured Patients

Abstract Introduction There has been growing evidence in trauma literature that differences in insurance status lead to inequality in treatment and outcome. Most studies comparing uninsured to insured patients were done in the USA. We sought to gain further insights into differences in the outcomes of trauma patients in a healthcare system with mandatory public health coverage by comparing publicly versus privately insured patients. Methods We used a prospective national quality assessment database from the Arbeitsgemeinschaft für Qualitätssicherung in der Chirurgie (AQC). More than 80 surgical departments in Switzerland are part of this quality program. We included all patients in the AQC database with any S- or T-code diagnosis according to the International Classification of Diseases ICD-10 (any injuries) who were treated during the 11-year period of 2004–2014. Missing insurance status information was an exclusion criterion. In total, 30,175 patients were included for analysis. The primary outcome was in-hospital mortality. Secondary outcomes included overall and intra- and postoperative complications. Bi- and multivariate analyses were performed, adjusted for insurance status, age, sex, American Society of Anesthesiologists (ASA) physical status category, type of injury, and surgeon’s level of experience. Results In total, 76.8% (n = 23,196) of the patients were publicly insured. Patients with public insurance were significantly younger (p < 0.001), more often male (p < 0.001), and in better general health according to the ASA physical status category (p < 0.001). Length of pre- and postoperative stay and the number of operations per case were similar in the two groups. Patients with public insurance had a lower mortality rate (1.3% vs. 1.9%, p < 0.001), but after adjusting for confounders, insurance status was not a predictor of mortality. Overall complication rates were significantly higher for publicly insured patients (8.4% vs. 6.2%, p < 0.001), and after adjusting for confounders, insurance status was identified as an independent risk factor for overall complications (p < 0.001). Conclusion Differences exist with respect to patient and procedural characteristics: publicly insured patients were younger, more often male, and scored better on ASA physical status. Insurance status seems not to be a predictor for fatal outcome after trauma, although it is associated with complications.

scholarly journals Pediatric and Adolescent Shoulder Instability: Does Insurance Status Predict Delays in Care, Outcomes, and Complication Rate?

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095933
Author(s):  
Nicole J. Hung ◽  
David M. Darevsky ◽  
Nirav K. Pandya
Keyword(s):  
Access To Care ◽  
Shoulder Instability ◽  
Insurance Status ◽  
Public Insurance ◽  
Recurrent Shoulder Instability ◽  
Adolescent Patients ◽  
Bony Injury ◽  
Labral Pathology ◽  
Publicly Insured ◽  
Insured Patients

Background: Recurrent shoulder instability results from overuse injuries that are often associated with athletic activity. Timely diagnosis and treatment are necessary to prevent further dislocations and secondary joint damage. In pediatric and adolescent patients, insurance status is a potential barrier to accessing timely care that has not yet been explored. Purpose: To examine the effect of insurance status on access to clinical consultation, surgical intervention, and surgical outcome of pediatric and adolescent patients with recurrent shoulder instability. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a retrospective review of pediatric and adolescent patients who were treated at a single tertiary children’s hospital for recurrent shoulder instability between 2011 and 2017. Patients were sorted into private and public insurance cohorts. Dates of injury, consultation, and surgery were recorded. Number of previous dislocations, magnetic resonance imaging (MRI) results, surgical findings, and postoperative complications were also noted. Delays in care were compared between the cohorts. The presence of isolated anterior versus complex labral pathology as well as bony involvement at the time of surgery was recorded. The incidences of labral pathology and secondary bony injury were then compared between the 2 cohorts. Postoperative notes were reviewed to compare rates of repeat dislocation and repeat surgery. Results: A total of 37 patients had public insurance, while 18 patients had private insurance. Privately insured patients were evaluated nearly 5 times faster than were publicly insured patients ( P < .001), and they obtained MRI scans over 4 times faster than did publicly insured patients ( P < .001). Publicly insured patients were twice as likely to have secondary bony injuries ( P = .016). Postoperatively, a significantly greater number (24.3%) of publicly insured patients experienced redislocation versus the complete absence of redislocation in the privately insured patients ( P = .022). Conclusion: Public insurance status affected access to care and was correlated with the development of secondary bony injury and a higher rate of postoperative dislocations. Clinicians should practice with increased awareness of how public insurance status can significantly affect patient outcomes by delaying access to care—particularly if delays lead to increased patient morbidity and health care costs.

scholarly journals PEDIATRIC AND ADOLESCENT SHOULDER INSTABILITY: DOES INSURANCE STATUS PREDICT THE DEVELOPMENT OF BONY BANKART AND ENGAGING HILL-SACHS LESIONS?

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0016
Author(s):  
NJ Hung ◽  
DM Darvesky ◽  
NK Pandya
Keyword(s):  
Shoulder Instability ◽  
Private Insurance ◽  
Insurance Status ◽  
Public Insurance ◽  
Repeat Surgery ◽  
Public And Private ◽  
Bony Injury ◽  
Labral Pathology ◽  
Publicly Insured ◽  
Insured Patients

Background: Pediatric and adolescent patients who undergo shoulder stabilization surgery have higher rates of failure than their adult counterparts. The impact of insurance status on intra-operative findings and outcomes is largely unknown. Hypothesis/Purpose: We hypothesized that patients with public insurance who undergo shoulder stabilization surgery would have greater degrees of bony pathology; leading to poor outcomes after stabilization. Methods: This was a retrospective cohort study of pediatric and adolescent patients with public and private insurance who were treated for recurrent shoulder instability from 2011-2017. Patients were treated at a tertiary care children’s hospital by a single orthopaedic surgeon. Patients 10 to 18 years of age were included in the study if they presented with recurrent shoulder instability and underwent surgical intervention for their injury. Time from injury to clinical consultation, imaging, and surgical intervention; incidences of labral pathology and secondary bony injury; and rates of repeat dislocation and repeat surgery were compared between the public and private insurance cohorts Results: Thirty-seven patients had public insurance while 18 patients had private insurance. Privately insured patients were evaluated by clinicians nearly five times faster than were publicly insured patients (p < 0.001), and they obtained MRIs over four times faster than did public insurance patients (p < 0.001). Publicly insured patients were twice as likely to have secondary bony injuries (p=0.043). Postoperatively, a significantly greater number (24.3%) of publicly insured patients experienced re-dislocation versus the complete absence of re-dislocation in the privately insured patients (p=0.022). Conclusion: Public insurance status impacts access to care and correlates with both the development of secondary bony injury and an increased rate of clinical failure manifested as repeat post-operative dislocations. [Table: see text] Table 1 shows the summary of results for public and private insurance cohorts for days from injury to clinic, injury to MRI, injury to surgery, clinic to MRI, MRI to surgery as well as number of prior dislocations, incidence of anterior only vs. complex labral pathology, incidence of bony involvement, incidence of repeat dislocations, and incidence of repeat surgery. * denotes that the difference between the two insurance cohorts was not statistically significant.

scholarly journals Association between Insurance Status and Hospital Length of Stay following Trauma

2016 ◽  
Vol 82 (3) ◽  
pp. 281-288 ◽  
Author(s):  
Brian R. Englum ◽  
Xuan Hui ◽  
Cheryl K. Zogg ◽  
Muhammad Ali Chaudhary ◽  
Cassandra Villegas ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Insurance Status ◽  
Trauma Patients ◽  
Uninsured Patients ◽  
National Trauma ◽  
Insured Patients ◽  
The Relationship

Previous research has demonstrated that nonclinical factors are associated with differences in clinical care, with uninsured patients receiving decreased resource use. Studies on trauma populations have also shown unclear relationships between insurance status and hospital length of stay (LOS), a commonly used metric for evaluating quality of care. The objective of this study is to define the relationship between insurance status and LOS after trauma using the largest available national trauma dataset and controlling for significant confounders. Data from 2007 to 2010 National Trauma Data Bank were used to compare differences in LOS among three insurance groups: privately insured, publically insured, and uninsured trauma patients. Multivariable regression models adjusted for potential confounding due to baseline differences in injury severity and demographic and clinical factors. A total of 884,493 patients met the inclusion criteria. After adjusting for the influence of covariates, uninsured patients had significantly shorter hospital stays (0.3 days) relative to privately insured patients. Publicly insured patients had longer risk-adjusted LOS (0.9 days). Stratified differences in discharge disposition and injury severity significantly altered the relationship between insurance status and LOS. In conclusion, this study elucidates the association between insurance status and hospital LOS, demonstrating that a patient's ability to pay could alter LOS in acute trauma patients. Additional research is needed to examine causes and outcomes from these differences to increase efficiency in the health care system, decrease costs, and shrink disparities in health outcomes.

Racial Disparities in Pediatric Acute Myeloid Leukemia during Induction

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 530-530
Author(s):  
Lena E. Winestone ◽  
Kelly Diringer Getz ◽  
Tamara P. Miller ◽  
Jennifer J. Wilkes ◽  
Leah Sack ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Research Funding ◽  
Public Insurance ◽  
Black Race ◽  
Black Patients ◽  
Publicly Insured ◽  
Insured Patients ◽  
Acute Myeloid ◽  
White Patients

Abstract Introduction: Black patients with acute myeloid leukemia (AML) have inferior overall survival relative to White patients. Few studies have evaluated differences in induction mortality and none has assessed the contribution of severity of illness at presentation to the disparity in survival. Our primary objectives were to compare induction mortality and acuity of presentation among Black relative to White patients and to assess whether any disparity in induction mortality is the consequence of differences in presentation acuity. In addition, we explored the interaction between Black race and public insurance on induction mortality with use of single referent models. Methods: Using a retrospective cohort of children (ages 0 to 18 years) from 2004 to 2014 with new-onset AML diagnosed and treated at free-standing pediatric hospitals who contribute inpatient information to the Pediatric Health Information System administrative database (PHIS), we evaluated inpatient mortality over two courses of standard induction chemotherapy. We examined race (Black versus White) as the primary exposure and insurance was considered with race using a common reference group. We also considered Intensive Care Unit (ICU)-level resource use during the first 72 hours following the initial AML admission as a surrogate for acuity at presentation and a potential mediator of the association between race and induction mortality. Results: 1,122 patients (183 Black, 939 White) with AML who received standard induction chemotherapy were included. Induction mortality for Blacks was substantially higher than for Whites (cHR= 2.31, 95% CI: 1.01, 5.42). Blacks also had a significantly higher risk of requiring any ICU-level care within the first 72 hours after initial presentation compared with Whites (cHR= 1.52, 95% CI: 1.02, 2.24).The association between race and induction mortality was attenuated following adjustment for ICU-level care within the initial 72 hours after admission, (aHR=1.42, 95% CI: 0.67, 2.99). Publicly insured patients experienced greater induction mortality than privately insured patients regardless of race. Induction mortality rates for Black and White patients were more similar among the privately insured and were increasingly disparate among the publicly insured. Conclusion: Our findings suggest that Black patients with AML present with more acute illness at initial diagnosis, accounting for up to 63% of the relative excess induction mortality. Identifying factors impacting acuity of illness at presentation and associated with public insurance may help to identify opportunities for intervention and thus narrow the current racial disparities in pediatric AML survival. Table 1. Inpatient Induction Mortality and ICU level Care by Race Outcome, Follow-up Period Overall (N=1122) n (%) Black (n=183) n (%) White (n=939) n (%) cHR (95% CI) aHRa (95% CI) Induction Death 27 (2.4%) 8 (4.4%) 19 (2.0%) 2.31 (1.01, 5.42) 1.42 (0.67, 2.99) Any ICU Level Care in first 72 hrs 135 (12.0%) 31 (16.9%) 104 (11.1%) 1.52 (1.04, 2.24) ICU involving >1 system in first 72 hrs 47 (4.2%) 18 (9.8%) 29 (3.1%) 3.35 (1.84, 6.12) Any ICU Level Care in Induction 237 (21.1%) 48 (26.2%) 189 (20.1%) 1.30 (0.99, 1.71) 1.09 (0.74, 1.61) ICU involving >1 system in Induction 99 (8.8%) 22 (12.0%) 77 (8.2%) 1.42 (0.85, 2.38) 0.92 (0.54, 1.57) a adjusted for ICU acuity score within the first 72 hours of index admission Figure 1. Independent and joint effects of Black race and public insurance on induction mortality Figure 1. Independent and joint effects of Black race and public insurance on induction mortality Disclosures Wilkes: Alex's Lemonade Stand Foundation: Research Funding; Healthcare Research and Quality: Research Funding. Fisher:Merck: Research Funding; Pfizer: Research Funding. Epstein:Medicus Economics: Consultancy. Aplenc:Sigma Tau: Consultancy.

scholarly journals UNEVEN PLAYING FIELD: INSURANCE STATUS ADVERSELY AFFECTS CHILDREN WITH TIBIAL SPINE FRACTURES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0012
Author(s):  
Neeraj M. Patel ◽  
Tomasina M. Leska ◽  
Theodore J. Ganley ◽  
Julien T. Aoyama ◽  
Aristides I. Cruz ◽  
...  
Keyword(s):  
Open Surgery ◽  
Continuous Passive Motion ◽  
Separate Analysis ◽  
Insurance Status ◽  
Spine Fractures ◽  
Public Insurance ◽  
Commercial Insurance ◽  
Tibial Spine ◽  
Publicly Insured ◽  
The Impact

Background: Previous studies have reported disparities in medical and surgical care resulting from demographic factors, including insurance status. Hypothesis/Purpose: The purpose of this study is to assess the impact of insurance status on the treatment of tibial spine fractures in children and adolescents. Methods: We performed a retrospective cohort study of tibial spine fractures treated at 10 institutions between 2000 and 2019. Polytraumas and patients older than 18 years were excluded. Demographic data was collected as was information regarding pre-operative, intra-operative, and post-operative treatment, with attention to delays in management and differences in care. Both surgical and non-surgical fractures were included, but a separate analysis of operative patients was performed subsequently. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: Data was collected on a total of 434 subjects with a mean age of 11.7±3.0. Of these, 61.1% had commercial insurance and 38.9% had public insurance. Publicly insured children were more likely to be injured in a motor vehicle accident. Among athletes, those with public insurance were injured more frequently during football while commercially insured patients were more likely to be injured while skiing. When analyzing the overall cohort of surgical and non-surgical fractures in multivariate analysis, those with magnetic resonance imaging (MRI) performed 21 or more days after injury were 5.3 times more likely to have public insurance (95% CI 1.3-21.7, p=0.02). Similar results were found with the 365 patients that required surgery. In this cohort, those with MRI delayed ≥21 days from injury were 4.8 times more likely to have public insurance (95% CI 1.2-19.6, p=0.03). Children that underwent surgery ≥21 days after injury were 2.2 times more likely to have public insurance (95% CI 1.1-4.1, p=0.02). Those that were publicly insured had 2.5 times higher odds of undergoing open surgery rather than arthroscopic (95% CI 1.1-6.1, p=0.04). These children also had 4.5 times lower odds of receiving a continuous passive motion machine (CPM) after surgery (95% CI 1.7-11.7, p=0.002) and were 4.0 times more likely to be immobilized in a cast rather than a brace post-operatively (95% CI 2.0-8.2, p<0.001). Conclusion: Children with public insurance and a tibial spine fracture were more likely to experience delays with MRI and surgical treatment than those with commercial insurance. Additionally, these patients were more likely to undergo open surgery and post-operative casting and less likely to receive a CPM machine.

scholarly journals Public Insurance Status Negatively Affects Access to Care in Pediatric Patients With Meniscal Injury

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097998
Author(s):  
Mara Olson ◽  
Nirav Pandya
Keyword(s):  
Access To Care ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Meniscal Tear ◽  
Safety Net ◽  
Insurance Status ◽  
Meniscal Injury ◽  
Publicly Insured ◽  
Insured Patients ◽  
Privately Insured

Background: Non- and underinsured individuals experience poor access to care and treatment delays. Meniscal injury is a common reason for surgical intervention in the pediatric population, and delays in care can lead to progression of the tear and other associated problems. Purpose: To investigate the impact of insurance status on access to care and severity of meniscal injury in the pediatric population. Study Design: Cohort study; Level of evidence, 3. Methods: Enrolled in this study were 49 patients receiving care for a meniscal injury between 2016 and 2018 from a safety-net medical system that does not prioritize patients based on insurance status. The patients were stratified into those publicly insured and those privately insured. Access to care was measured as wait time to various points of care: initial injury to clinic, injury to magnetic resonance imaging (MRI), injury to surgery, clinic to MRI, clinic to surgery, and MRI to surgery. The severity of the meniscal tear was measured by findings at the time of arthroscopy, including the type of tear identified, surgery performed, and cartilage injury. Results: Publicly insured patients waited a mean 230 days longer (347 vs 117 days; P < .01) to undergo surgery after injury compared with privately insured patients. The mean wait times in all categories except time from MRI to surgery were significantly longer for publicly insured patients, including injury to clinic (212 vs 73 days; P < .01), injury to MRI (260 vs 28 days; P < .001), injury to surgery (347 vs 117 days; P < .01), clinic to MRI (36 vs 3.9 days; P < .001), and clinic to surgery (136 vs 44 days; P < .01). Neither increased wait times nor insurance status were associated with greater surgical repair rate, severe tear type, or cartilage injury. Conclusion: Publicly insured pediatric patients waited significantly longer for a diagnosis of meniscal tear compared with privately insured patients, even in a safety-net setting. These delays were not associated with greater tear severity or cartilage changes. Providers in all models of care should recognize that insurance status and the socioeconomic factors it represents prevent publicly insured patients from timely diagnostic points of care and strive to minimize the resulting delayed return to normal activity as well as the potential long-term clinical effects thereof.

scholarly journals Impact of Insurance Status on the Day of Admission and Clinical Outcome on Acute Myeloid Leukemia (AML)Patients

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2274-2274
Author(s):  
Bilal Ahmad ◽  
Hossein Maymani ◽  
Haseeb Saeed ◽  
Mohamad Khawandanah ◽  
Samer A Srour ◽  
...  
Keyword(s):  
Overall Survival ◽  
Myeloid Leukemia ◽  
Private Insurance ◽  
P Value ◽  
Insurance Status ◽  
Uninsured Patients ◽  
Public Insurance ◽  
Group 2 ◽  
Insured Patients ◽  
Group 1

Abstract Background: In patients with acute myeloid leukemia (AML), insurance status has not been demonstrated to adversely impact outcomes. However, insurance status appears to be an independent factor in healthcare utilization. University of Oklahoma Health Sciences Center (OUHSC) is the main tertiary hospital in the State of Oklahoma treating patients with acute leukemia. We hypothesized that treatment patterns might be different between the insured and uninsured patients. We hereby attempt to analyze the association between insurance status, week day of admission and outcomes. Methods: We retrospectively analyzed patients from January 2000 to June 2012 diagnosed with AML over 18 years of age, who were treated at OUHSC with induction chemotherapy. Patients were divided into two groups: Group 1 included patients who were admitted on weekdays (Monday-Thursday) and group 2 included patients admitted on weekends (Friday-Sunday). Patients were also sub-classified as having private insurance, public insurance (Medicaid and Medicare) or no insurance. Primary outcomes were overall survival at follow up (OS), complete remission (CR) and Relapse. Chi-Square analysis was utilized to assess if day of admission and insurance status was related to OS, CR and Relapse. Cox Proportional hazards model was used to measure association of insurance status, day of admission and their interaction and Kaplan Meir Survival curves were used to estimate survival rates for day of admission by insurance status. Results: We analyzed total of 161 patients, 157 met inclusion criteria with 69 (44%) having public insurance, 58 (37%) with private insurance and 30 (19%) were uninsured. Group 1 with 94 (60%) patients was admitted on weekdays (Monday–Thursday), and group 2 with 63 (40%) patients was admitted on weekend (Friday-Sunday). The median age at diagnosis was 49 years, 63.7% male 36.3% female. 77.0% white, 10.6% African American, 6.2% Native American and 3.7% Hispanic. We found a significant interaction between insurance status and day of admission, 63% of uninsured patients being admitted on weekend (Fri-Sun) with (p-value=0.0292). When we stratified patients by insurance status there was no difference in survival outcomes for uninsured patients based on day of admission. However, for patients with insurance who were admitted on weekdays Mon-Thurs (Group 1) had a hazard ratio (HR) of death 0.487 relative to those on weekends Fri-Sun (Group 2) (p=0.0238). Median overall survival (OS) for uninsured patients in (Group 2) was 147.5 days (95% CI=79-252) as compare to insured patients in (Group 1) 252 days (95% CI=116-459) with a P value 0.0182. The proportion of patients achieving CR did not differ by day of admission (p=0.3275) and insurance type (0.5678). Relapse was not associated with day of admission (p=0.2284) or by insurance type (p=0.4057). Conclusions: For the patients with the diagnosis of AML who presented to our institution, there was a noticeable trend of uninsured patients being admitted over the weekend. The overall survival was lower for the uninsured patients who were admitted on the weekend as compare to the insured patients who were admitted on weekdays. This trend is both noteworthy and significant and due to its possible impact on standard of care warrants further investigation. Disclosures No relevant conflicts of interest to declare.

scholarly journals Impact of Insurance Status on Time to Evaluation and Treatment of Meniscal Tears in Children, Adolescents, and College-Aged Patients in the United States

2019 ◽  
Vol 7 (10) ◽  
pp. 232596711987507 ◽  
Author(s):  
Taylor R. Johnson ◽  
Alexander Nguyen ◽  
Kush Shah ◽  
Grant D. Hogue
Keyword(s):  
Meniscal Tear ◽  
The United States ◽  
Insurance Status ◽  
Meniscal Tears ◽  
Aged Patients ◽  
Surgical Interventions ◽  
Orthopaedic Care ◽  
Children And Young Adults ◽  
Publicly Insured ◽  
Insured Patients

Background: The meniscus is vital for load bearing, knee stabilization, and shock absorption, making a meniscal tear a well-recognized sport-related injury in children and young adults. An inverse relationship between the quality and value of orthopaedic care provided and the overall treatment cycle exists in which delayed meniscal tear treatment increases the likelihood of unfavorable outcomes. Although a majority of children and young adults have health insurance, many athletes within this demographic still face significant barriers in accessing orthopaedic services because of insurance type and household income. Purpose: To determine the impact of insurance status and socioeconomic markers on the time to orthopaedic evaluation and treatment as well as the rate of surgical interventions for meniscal tears in children and young adult athletes in the United States. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a retrospective review of all patients ≤22 years of age who presented to our institution between 2008 and 2016 and who were diagnosed with meniscal tears. Patients were categorized based on insurance and socioeconomic status. Dates of injury, referral, evaluation by an orthopaedic surgeon, and surgery were also recorded. Chi-square and regression analyses were utilized to determine the significance and correlation between the influencing factors and time to referral, evaluation, and surgery. Results: Publicly insured, commercially insured, and uninsured patients comprised 49.4%, 26.6%, and 24.1%, respectively, of the 237 patients included in this study. Insurance status was predictive of time to orthopaedic referral, initial evaluation, and surgery ( P < .01). Uninsured and publicly insured patients experienced significant delays during their orthopaedic care compared with commercially insured patients. However, no correlation was found between insurance status or household income and the rate of surgical interventions. Conclusion: Publicly insured and uninsured pediatric and college-aged patients faced significant barriers in accessing orthopaedic services, as demonstrated by substantially longer times between the initial injury and referral to an orthopaedic evaluation and surgery; however, these socioeconomic factors did not affect the rate of surgical management. Clinical competency regarding the effects of socioeconomic factors on the time to orthopaedic care and efforts to expedite care among underinsured and underserved children are vital for improving patient outcomes.

scholarly journals Uneven Playing Field: Insurance Status Adversely Affects Children with Tibial Spine Fractures (181)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0029
Author(s):  
Neeraj Patel ◽  
Tomasina Leska ◽  
Theodore Ganley ◽  
Julien Aoyama ◽  
Aristides Cruz ◽  
...  
Keyword(s):  
Open Surgery ◽  
Continuous Passive Motion ◽  
Separate Analysis ◽  
Insurance Status ◽  
Spine Fractures ◽  
Public Insurance ◽  
Commercial Insurance ◽  
Tibial Spine ◽  
Publicly Insured ◽  
The Impact

Objectives: Previous studies have reported disparities in medical and surgical care resulting from demographic factors, including insurance status. Tibial spine fractures are uncommon injuries, which may exacerbate potential disparities in care. The purpose of this study is to assess the impact of insurance status on the treatment of tibial spine fractures in children and adolescents. Methods: We performed a retrospective cohort study of tibial spine fractures treated at 10 institutions between 2000 and 2019. Polytraumas and patients older than 18 years were excluded. Demographic data was collected as was information regarding pre-operative, intra-operative, and post-operative treatment, with attention to delays in management and differences in care. Both surgical and non-surgical fractures were included, but a separate analysis of operative patients was performed subsequently. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: Data was collected on a total of 434 subjects with a mean age of 11.7±3.0. Of these, 61.1% had commercial insurance and 38.9% had public insurance. Publicly insured children were more likely to be injured in a motor vehicle accident. Among athletes, those with public insurance were injured more frequently during football while commercially insured patients were more likely to be injured while skiing. When analyzing the overall cohort of surgical and non-surgical fractures in multivariate analysis, those with magnetic resonance imaging (MRI) performed 21 or more days after injury were 5.3 times more likely to have public insurance (95% CI 1.3-21.7, p=0.02). Similar results were found with the 365 patients that required surgery. In this cohort, those with MRI delayed ≥21 days from injury were 4.8 times more likely to have public insurance (95% CI 1.2-19.6, p=0.03). Children that underwent surgery ≥21 days after injury were 2.2 times more likely to have public insurance (95% CI 1.1-4.1, p=0.02). Those that were publicly insured had 2.5 times higher odds of undergoing open surgery rather than arthroscopic (95% CI 1.1-6.1, p=0.04). These children also had 4.5 times lower odds of receiving a continuous passive motion machine (CPM) after surgery (95% CI 1.7-11.7, p=0.002) and were 4.0 times more likely to be immobilized in a cast rather than a brace post-operatively (95% CI 2.0-8.2, p<0.001). Conclusions: Children with public insurance and a tibial spine fracture were more likely to experience delays with MRI and surgical treatment than those with commercial insurance. Additionally, these patients were more likely to undergo open surgery and post-operative casting and less likely to receive a CPM machine.

scholarly journals Differences in healthcare expenditures for inflammatory bowel disease by insurance status, income, and clinical care setting

2014 ◽  
Author(s):  
Michelle Park ◽  
Jay Bhattacharya ◽  
KT Park
Keyword(s):  
Inflammatory Bowel Disease ◽  
Low Income ◽  
Bowel Disease ◽  
Clinical Care ◽  
The United States ◽  
Medical Expenditure ◽  
Insurance Status ◽  
Inflammatory Bowel ◽  
Publicly Insured ◽  
Insured Patients

Background: Socioeconomic factors and insurance status have not been correlated with differential use of healthcare services in inflammatory bowel disease (IBD). Aim: To describe IBD-related expenditures based on insurance and household income with the use of inpatient, outpatient, emergency, and office-based services, and prescribed medications in the United States (US). Methods: We evaluated the Medical Expenditure Panel Survey from 1996 to 2011 of individuals with Crohn’s disease (CD) or ulcerative colitis (UC). Nationally weighted means, proportions, and multivariate regression models examined the relationships between income and insurance status with expenditures. Results: Annual per capita mean expenditures for CD, UC, and all IBD were $10,364 (N=238), $7,827 (N=95), and $9,528, respectively, significantly higher than non-IBD ($4,314, N=276,372, p<0.05). Publicly insured patients incurred the highest costs ($18,067), over privately insured ($8,014, p<0.05) or uninsured patients ($5,129, p<0.05). Among all IBD patients, inpatient care composed the highest proportion of costs ($3,392, p<0.05). Inpatient costs were disproportionately higher for publicly insured patients. Public insurance had higher odds of total costs than private (OR 2.13, CI 1.08-4.19) or no insurance (OR 4.94, CI 1.26-19.47), with increased odds for inpatient and emergency care. Private insurance had higher costs associated with outpatient care, office-based care, and prescribed medicines. Low-income patients had lower costs associated with outpatient (OR 0.38, CI 0.15-0.95) and office-based care (OR 0.21, CI 0.07-0.62). Conclusions: In the US, high inpatient utilization among publicly insured patients is a previously unrecognized driver of high IBD costs. Bridging this health services gap between SES strata for acute care services may curtail direct IBD-related costs.

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