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Tytuł:
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Does Medicaid expansion improve access to care for the first-time shoulder dislocator?
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Autorzy:
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Kirchner GE; Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Rivers NJ; Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Balogh EF; Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Huntley SR; Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
MacLennan PA; Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Ponce BA; Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Brabston EW; Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Momaya AM; Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: .
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Źródło:
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Journal of shoulder and elbow surgery [J Shoulder Elbow Surg] 2019 Nov; Vol. 28 (11), pp. 2079-2083. Date of Electronic Publication: 2019 Sep 11.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: St. Louis, MO : Mosby
Original Publication: St. Louis, MO : Mosby Yearbook, Inc., c1992-
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MeSH Terms:
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Health Services Accessibility*
Insurance Coverage*
Insurance, Health*
Medicaid*
Shoulder Dislocation/*surgery
Adolescent ; Appointments and Schedules ; Humans ; Patient Protection and Affordable Care Act ; United States
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Contributed Indexing:
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Keywords: Medicaid; Shoulder; access; appointment; dislocate; health care
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Entry Date(s):
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Date Created: 20190916 Date Completed: 20200127 Latest Revision: 20200127
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Update Code:
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20240105
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DOI:
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10.1016/j.jse.2019.07.008
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PMID:
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31521525
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Background: The purpose of this study was to assess the effect of individual state Medicaid expansion status on access to care for shoulder instability.
Methods: Four pairs of Medicaid expanded (Louisiana, Kentucky, Iowa, and Nevada) and unexpanded (Alabama, Virginia, Wisconsin, and Utah) states in similar geographic locations were chosen for the study. Twelve practices from each state were randomly selected from the American Orthopedic Society for Sports Medicine directory, resulting in a sample size of 96 independent sports medicine offices. Each office was called twice to request an appointment for a fictitious 16-year-old first-time shoulder dislocator with either in-state Medicaid insurance or Blue Cross Blue Shield (BCBS) private insurance.
Results: A total of 91 physician offices in 8 states were contacted by telephone. An appointment was obtained at 36 (39.6%) offices when calling with Medicaid and at 74 (81.3%) offices when calling with BCBS (P < .001). Thirty-five (38.5%) offices were able to make appointments for both types of insurance, 39 (42.9%) for only BCBS, 1 (1.1%) for only Medicaid, and 16 (17.5%) for neither. For Medicaid patients, an appointment was booked in 13 (27.7%) clinics from Medicaid expanded states and in 23 (52.3%) clinics from unexpanded states (P = .016).
Conclusion: For a first-time shoulder dislocator, access to care is more difficult with Medicaid insurance compared with private insurance. Within Medicaid insurance, access to care is more difficult in Medicaid expanded states compared with unexpanded states. Medicaid patients in unexpanded states are twice as likely as those in expanded states to obtain an appointment.
(Copyright © 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
