Original Research

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

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  • 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.




The purpose of this study is to assess the effect of insurance type (Medicaid, Medicare, private insurance) on the ability for patients with operative ankle fractures to access orthopedic traumatologists. The research team called 245 board-certified orthopedic surgeons specializing in orthopedic trauma within 8 representative states. The caller requested an appointment for their fictitious mother in order to be evaluated for an ankle fracture which was previously evaluated by her primary care physician and believed to require surgery. Each office was called 3 times to assess the response for each insurance type. For each call, information was documented regarding whether the patient was able to receive an appointment and the barriers the patient confronted to receive an appointment. Overall, 35.7% of offices scheduled an appointment for a patient with Medicaid, in comparison to 81.4%and 88.6% for Medicare and BlueCross, respectively (P < .0001). Medicaid patients confronted more barriers for receiving appointments. There was no statistically significant difference in access for Medicaid patients in states that had expanded Medicaid eligibility vs states that had not expanded Medicaid. Medicaid reimbursement for open reduction and internal fixation of an ankle fracture did not significantly correlate with appointment success rates or wait times. Despite the passage of the Affordable Care Act, patients with Medicaid have reduced access to orthopedic surgeons and more complex barriers to receiving appointments. A more robust strategy for increasing care-access for patients with Medicaid would be more equitable.

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