Public insurance may lead to surgical delays in patients with distal radius fractures
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Key takeaways:
- Results showed public insurance may be associated with delays in time to surgery compared with private insurance.
- Younger patient age also may be associated with greater delays in time to surgery.
SAN FRANCISCO — Public insurance may be associated with delays in time to surgery compared with private insurance in patients with distal radius fractures, according to results presented here.
“Insurance is a driver of differences in time to surgery for patients with distal radius fractures,” Jeffrey W. K. Kwong, MD, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting. “This was due to longer time to first clinic visit in patients with public insurance, suggesting that patients with public insurance face greater barriers to scheduling an appointment with an orthopedic surgeon.”
Kwong and colleagues retrospectively collected data on 195 adults who underwent operative management for distal radius fractures between 2018 and 2021.
Patients were categorized into groups based on whether they had private or public insurance. Private insurance included commercial insurance, Medicare with a commercial supplement or insurance obtained through health insurance marketplaces. Public insurance included Medicare and Medicaid.
Outcomes measured included time to surgery and covariates including demographics, preferred language of care and American Society of Anesthesiologists classification. Kwong said time to surgery was broken down by time from injury to first clinic visit and time from first clinic visit to surgery.
Kwong said patients with public insurance had an average time to surgery of 17.6 days compared with 10.6 days to surgery in the private insurance group.
“A Cox model indicated that patients with public insurance had half the odds of receiving surgery at any given timepoint. This was also statistically significant,” Kwong said. “Breaking this down, we found this disparity was due to longer time from injury to first clinic visit. The time from clinic visit to surgery was similar between the two groups.”
In addition, Kwong said younger patient age and having a preferred language other than English were associated with greater delays in time to surgery. However, he said preferred language was not statistically significant in findings from a multivariate regression analysis.
“Our results suggest insurance type is a cause of inequity in musculoskeletal health and strategies to mitigate these inequities are needed such as standardized preoperative protocols and hospital quality metrics such as financial incentives or penalties to reward equitable care on the basis of insurance type,” Kwong concluded.
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Kwong JWK, et al. Paper 282. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Feb. 12-16, 2024; San Francisco.
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