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The Effect of Insurance Type on Patient Access to Ankle Fracture Care Under the Affordable Care Act

September 13, 2018 | Surgery
Daniel H. Wiznia, MD ; Mike Wang, BS ; Chang-Yeon Kim, MD ; Michael P. Leslie, DO
Author and Disclosure Information

Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.

Dr. Wiznia is an Assistant Professor of Orthopaedic Surgery, Department of Orthopaedics and Rehabilitation; Mr. Wang is a medical student; and Dr. Leslie is an Associate Professor of Orthopaedics and Rehabilitation, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut. Dr. Kim is an Orthopedic Surgery Resident, University Hospitals Cleveland Medical Center, Cleveland, Ohio. Dr. Wiznia was a resident at the time the article was written.

Address correspondence to: Daniel H. Wiznia, MD, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, Connecticut 06510 (tel, 203-737-6358; email, daniel.wiznia@yale.edu).

Daniel H. Wiznia, MD Mike Wang, BS Chang-Yeon Kim, MD Michael P. Leslie, DO . The Effect of Insurance Type on Patient Access to Ankle Fracture Care Under the Affordable Care Act. Am J Orthop. September 13, 2018

TAKE-HOME POINTS

  • One method in which the PPACA increased the number of individuals with health insurance coverage was by expanding Medicaid eligibility requirements.
  • Despite this, Medicaid patients confronted more barriers to accessing care.
  • The overall rate of successfully being offered an appointment with Medicaid was 35.7%, 81.4% for Medicare, and 88.6% for BlueCross. Patients with Medicaid also confronted longer appointment wait times.
  • The disparity in access for this operative trauma scenario suggests that patients with Medicaid are likely to be excluded from the practice of their choice and may need to make considerably more effort to secure an appointment.
  • Ultimately, Medicaid patients may have access to care through federally funded community health centers and public and non-profit safety net hospitals, which generally care for more uninsured and Medicaid patient populations.

In 2010, the Patient Protection and Affordable Care Act (PPACA) expanded the eligibility criteria for Medicaid to all individuals with an income up to 138% of the poverty level.1 A Supreme Court ruling stated that the decision to expand Medicaid was to be decided by individual states.2 Currently, 31 states have chosen to expand Medicaid eligibility to their residents.2 This expansion has allowed an additional 11.7 million people to enroll in Medicaid and the Children’s Health Insurance Program by May 2015.3-5

Even with the passage of the PPACA, Medicaid patients seeking specialty orthopedic care have experienced more barriers to accessing care than Medicare or commercially-insured patients.2,6-10 One major cited reason is Medicaid’s low reimbursement, which may discourage physicians from open panel participation in Medicaid.11,12  

A common fundamental teaching for orthopedic traumatologists is the notion that they should be available to treat all injuries regardless of the patient’s ability to pay.13 This has resulted in both trauma centers and trauma surgeons becoming financially challenged due to the higher proportion of Medicaid and uninsured trauma patients and lower Medicaid reimbursement levels.14,15

This study focuses on the effect of different types of insurance (Medicaid, Medicare, or commercial insurance) on the ability of patients to obtain care for operative ankle fractures. The purpose of this study is to evaluate, in the context of the PPACA, patient access to orthopedic surgeons for operative ankle fractures based on insurance-type. We hypothesized that patients with Medicaid would face a greater volume of obstacles when seeking appointments for an ankle fracture, even after the PPACA.

Continue to: MATERIALS AND METHODS...

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