The Influence of Medical Insurance on Patient Access to Orthopaedic Surgery Sports Medicine Appointments Under the Affordable Care Act

Abstract

Background:The goal of the Patient Protection and Affordable Care Act (PPACA) was to expand patient access to health care. Since the rollout of the PPACA, Medicaid patients have demonstrated difficulty obtaining appointments in some specialty care settings.Purpose:To assess the effect of insurance type (Medicaid and private) on patient access to orthopaedic surgery sports medicine specialists for a semiurgent evaluation of a likely operative bucket-handle meniscus tear. The study was designed to determine whether disparities in access exist since the PPACA rollout.Study Design:Cohort study; Level of evidence, 2.Methods:The design was to call 180 orthopaedic surgery sports medicine specialists in 6 representative states (California, Ohio, New York, Florida, Texas, and North Carolina) between June 2015 and December 2015. An appointment was requested for the caller’s fictitious 25-year-old-brother who had suffered a bucket-handle meniscus tear. Each office was called twice to assess the ease of obtaining an appointment: once for patients with Medicaid and once for patients with private insurance. For each call, data pertaining to whether an appointment was given, wait times, and barriers to receiving an appointment were recorded.Results:A total of 177 surgeons were called within the study period. Overall, 27.1% of offices scheduled an appointment for a patient with Medicaid, compared with 91.2% (P < .0001) for a patient with private insurance. Medicaid patients were significantly more likely to be denied an appointment due to lack of referral compared with private patients (40.2% vs 3.7%, P < .0001), and Medicaid patients were more likely to experience longer wait times for an appointment (15 vs 12 days, P < .029). No significant differences were found in patients’ access to orthopaedic surgery sports medicine specialists between Medicaid-expanded and -nonexpanded states. Medicaid reimbursement for knee arthroscopy with meniscus repair was not significantly correlated with appointment success rate or patient waiting periods.Conclusion:Despite the passage of the PPACA, patients with Medicaid have reduced access to care. In addition, patients with Medicaid confront more barriers to receiving appointments than patients with private insurance and wait longer for an appointment.

Associations of Socioeconomic Status, Public vs Private Insurance, and Race/Ethnicity With Metastatic Sarcoma at Diagnosis

“…Both Medicaid insured and uninsured patients can experience numerous barriers to receiving medical care, including reduced access to regular sources of health care services, prolonged referral times to specialists, an inability to navigate the health care system, transportation issues, or poor psychosocial support. [39][40][41][42][43][44] Our study concurs with a prior analysis 45 that reported an elevated risk of metastatic presentation in Medicaid insured patients diagnosed with STS of the extremities. Moreover, it builds on prior work in part because our analyses were stratified by sarcoma subtype, thereby providing a more detailed overview regarding the extent to which delayed access to medical care is associated with sarcoma stage at presentation.…”

Differences in caesarean rates across women's socio‐economic status by diverse obstetric indications: Cross‐sectional study

“…Importantly, factors that are related to the caesarean rate, such as maternal age, parity, race, and obstetric complications, do not fully account for the consistently high rates observed . The high socio‐economic variation in access to health care and the variable reimbursement rate for medical procedures from private insurance versus Medicaid may influence women's access to caesareans and physician's willingness to offer caesareans to their patients . Thus, studying caesarean rates across socio‐economic groups may allow for a better understanding of the current rates.…”

“…9 The high socio-economic variation in access to health care and the variable reimbursement rate for medical procedures from private insurance versus Medicaid may influence women's access to caesareans and physician's willingness to offer caesareans to their patients. 10,11 Thus, studying caesarean rates across socio-economic groups may allow for a better understanding of the current rates.…”

Impact of Insurance and Practice Type on Access to Orthopaedic Sports Medicine

“…In the literature, there was a similar study published in 2017 looking at access to care based on insurance. 34 They found a similar result in that Medicaid patients had a harder time getting an appointment along with long wait times until an appointment. 34 In addition, they found that the Medicaid expansion versus nonexpanded states did not have any significant difference in access to care.…”

“…34 They found a similar result in that Medicaid patients had a harder time getting an appointment along with long wait times until an appointment. 34 In addition, they found that the Medicaid expansion versus nonexpanded states did not have any significant difference in access to care. 34 Multiple other studies 2,21,26 have looked at access to care for orthopaedics among other subspecialties.…”