Impact of Payer Type on Resource Utilization, Outcomes and Access to Care in Total Hip Arthroplasty

Does Medicaid Insurance Confer Adequate Access to Adult Orthopaedic Care in the Era of the Patient Protection and Affordable Care Act?

“…The results of our study corroborate those of previous studies, which consistently show that patients with Medicaid face increased challenges during the course of orthopaedic care; patients with Medicaid must travel farther to obtain orthopaedic care, wait a longer time before accessing care, are delayed in receiving the diagnosis of an acute orthopaedic injury, experience disruption in continuity of ambulatory care, and experience worse outcomes after surgery compared with patients with different health insurance [3,9,11,19]. Pierce et al [14] observed that the pediatric patients with Medicaid seeking outpatient care for an ACL tear before Medicaid expansion were 57 times less likely to receive an appointment within 2 weeks compared with a child with private insurance.…”

“…A central tenet of the PPACA was the belief that increased Medicaid eligibility would result in improved access to healthcare and improved outcomes for the uninsured and underinsured [12]. Before passage of the PPACA, several studies found that adult patients with Medicaid experience poorer continuity of care, delayed diagnoses, and worse outcomes than their counterparts with private insurance [3,9,19].…”

A Regional Assessment of Medicaid Access to Outpatient Orthopaedic Care: The Influence of Population Density and Proximity to Academic Medical Centers on Patient Access

“…Calfee et al investigated patients with hand and upperextremity conditions and found that patients with Medicaid were traveling farther distances for appointments with specialists than patients with private insurance or Medicare 10 . For patients undergoing total hip arthroplasty, similar results have been seen, as patients with Medicaid were driving farther to obtain care at an academic hospital than patients with private insurance or Medicare 11 . These findings are in contrast to other published literature, as there is evidence indicating that rural pediatric and primary care practices are more likely to accept patients with Medicaid compared with similar practices in urban settings 12,13 .…”

“…To define driving distance as a categorical variable, a distance of sixty miles from the closest academic medical center was used as the cutoff value. We selected sixty miles as the cutoff value because previous literature has shown that, on average, patients with Medicaid drive at least sixty miles for outpatient orthopaedic care for elective surgery 11 . Population size was analyzed as a continuous and dichotomous variable.…”

Patient-Reported Allergies Are Associated With Poorer Patient Satisfaction and Outcomes After Lower Extremity Arthroplasty: A Retrospective Cohort Study

“…While surgeon experience, surgical technique, and implant choice are important factors, patient-specific characteristics may adversely affect patient satisfaction and patient-reported outcomes (PROs) after lower extremity arthroplasty [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Anecdotal observation suggests that patients with multiple patient-reported allergies (PRAs) may represent a clinically challenging group of patients, who report worse satisfaction and outcomes after orthopedic surgery.…”