Effect of insurance status on the rate of surgery following a meniscal tear

Kenneth Gundle, Timothy J. McGlaston, Arun J. Ramappa

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Uninsured and underinsured Americans face barriers to access to medical care. The objective of this study was to characterize the effect of insurance status on whether patients with a torn meniscus proceed to elective arthroscopic knee surgery. Methods: The records from January 2003 through April 2006 at a single academic orthopaedic surgery institution in Massachusetts were retrospectively reviewed to identify patients diagnosed with a meniscal tear and to determine whether surgery had been performed within six months after the diagnosis. Six categories of insurance were identified: private insurance, Workers' Compensation, Medicare, Medicaid, Uncompensated Care Pool, and self pay. A comparison of the proportions of insured and uninsured patients who underwent surgery was the primary outcome measure. Results: A total of 1127 patients were identified, and 446 (40%) of them underwent surgery within six months after an office visit. The patients with and without surgery had similar age and sex distributions. When patients were divided, according to their insurance status, into insured and uninsured groups, no significant difference was found in the rate of surgery (p = 0.23). However, subgroup analysis revealed significant differences among the six insurance categories. Logistic regression analysis showed that patients in the self-pay group had a lower rate of surgery than those with private insurance (odds ratio, 0.33; 95% confidence interval, 0.14 to 0.75; p = 0.008), whereas patients receiving Workers' Compensation (odds ratio, 1.93; 95% confidence interval, 1.05 to 3.55; p = 0.034) and those receiving Medicaid (odds ratio, 1.63; 95% confidence interval, 1.09 to 2.42; p = 0.016) had higher surgical rates than those with private insurance. Conclusions: The rate of elective arthroscopic knee surgery for meniscal tears varied significantly for some insurance categories at this single academic institution in Massachusetts. Further work is necessary to clarify the patient and surgeon factors influencing these disparities in clinical decision-making. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)2452-2456
Number of pages5
JournalJournal of Bone and Joint Surgery - Series A
Volume92
Issue number14
DOIs
StatePublished - Oct 20 2010
Externally publishedYes

Fingerprint

Insurance Coverage
Tears
Insurance
Workers' Compensation
Odds Ratio
Arthroscopy
Medicaid
Confidence Intervals
Knee
Uncompensated Care
Office Visits
Sex Distribution
Age Distribution
Medicare
Orthopedics
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Effect of insurance status on the rate of surgery following a meniscal tear. / Gundle, Kenneth; McGlaston, Timothy J.; Ramappa, Arun J.

In: Journal of Bone and Joint Surgery - Series A, Vol. 92, No. 14, 20.10.2010, p. 2452-2456.

Research output: Contribution to journalArticle

Gundle, Kenneth ; McGlaston, Timothy J. ; Ramappa, Arun J. / Effect of insurance status on the rate of surgery following a meniscal tear. In: Journal of Bone and Joint Surgery - Series A. 2010 ; Vol. 92, No. 14. pp. 2452-2456.
@article{9eb4d766603b418791f1da29da2e1644,
title = "Effect of insurance status on the rate of surgery following a meniscal tear",
abstract = "Background: Uninsured and underinsured Americans face barriers to access to medical care. The objective of this study was to characterize the effect of insurance status on whether patients with a torn meniscus proceed to elective arthroscopic knee surgery. Methods: The records from January 2003 through April 2006 at a single academic orthopaedic surgery institution in Massachusetts were retrospectively reviewed to identify patients diagnosed with a meniscal tear and to determine whether surgery had been performed within six months after the diagnosis. Six categories of insurance were identified: private insurance, Workers' Compensation, Medicare, Medicaid, Uncompensated Care Pool, and self pay. A comparison of the proportions of insured and uninsured patients who underwent surgery was the primary outcome measure. Results: A total of 1127 patients were identified, and 446 (40{\%}) of them underwent surgery within six months after an office visit. The patients with and without surgery had similar age and sex distributions. When patients were divided, according to their insurance status, into insured and uninsured groups, no significant difference was found in the rate of surgery (p = 0.23). However, subgroup analysis revealed significant differences among the six insurance categories. Logistic regression analysis showed that patients in the self-pay group had a lower rate of surgery than those with private insurance (odds ratio, 0.33; 95{\%} confidence interval, 0.14 to 0.75; p = 0.008), whereas patients receiving Workers' Compensation (odds ratio, 1.93; 95{\%} confidence interval, 1.05 to 3.55; p = 0.034) and those receiving Medicaid (odds ratio, 1.63; 95{\%} confidence interval, 1.09 to 2.42; p = 0.016) had higher surgical rates than those with private insurance. Conclusions: The rate of elective arthroscopic knee surgery for meniscal tears varied significantly for some insurance categories at this single academic institution in Massachusetts. Further work is necessary to clarify the patient and surgeon factors influencing these disparities in clinical decision-making. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.",
author = "Kenneth Gundle and McGlaston, {Timothy J.} and Ramappa, {Arun J.}",
year = "2010",
month = "10",
day = "20",
doi = "10.2106/JBJS.I.01369",
language = "English (US)",
volume = "92",
pages = "2452--2456",
journal = "Journal of Bone and Joint Surgery - American Volume",
issn = "0021-9355",
publisher = "Journal of Bone and Joint Surgery Inc.",
number = "14",

}

TY - JOUR

T1 - Effect of insurance status on the rate of surgery following a meniscal tear

AU - Gundle, Kenneth

AU - McGlaston, Timothy J.

AU - Ramappa, Arun J.

PY - 2010/10/20

Y1 - 2010/10/20

N2 - Background: Uninsured and underinsured Americans face barriers to access to medical care. The objective of this study was to characterize the effect of insurance status on whether patients with a torn meniscus proceed to elective arthroscopic knee surgery. Methods: The records from January 2003 through April 2006 at a single academic orthopaedic surgery institution in Massachusetts were retrospectively reviewed to identify patients diagnosed with a meniscal tear and to determine whether surgery had been performed within six months after the diagnosis. Six categories of insurance were identified: private insurance, Workers' Compensation, Medicare, Medicaid, Uncompensated Care Pool, and self pay. A comparison of the proportions of insured and uninsured patients who underwent surgery was the primary outcome measure. Results: A total of 1127 patients were identified, and 446 (40%) of them underwent surgery within six months after an office visit. The patients with and without surgery had similar age and sex distributions. When patients were divided, according to their insurance status, into insured and uninsured groups, no significant difference was found in the rate of surgery (p = 0.23). However, subgroup analysis revealed significant differences among the six insurance categories. Logistic regression analysis showed that patients in the self-pay group had a lower rate of surgery than those with private insurance (odds ratio, 0.33; 95% confidence interval, 0.14 to 0.75; p = 0.008), whereas patients receiving Workers' Compensation (odds ratio, 1.93; 95% confidence interval, 1.05 to 3.55; p = 0.034) and those receiving Medicaid (odds ratio, 1.63; 95% confidence interval, 1.09 to 2.42; p = 0.016) had higher surgical rates than those with private insurance. Conclusions: The rate of elective arthroscopic knee surgery for meniscal tears varied significantly for some insurance categories at this single academic institution in Massachusetts. Further work is necessary to clarify the patient and surgeon factors influencing these disparities in clinical decision-making. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

AB - Background: Uninsured and underinsured Americans face barriers to access to medical care. The objective of this study was to characterize the effect of insurance status on whether patients with a torn meniscus proceed to elective arthroscopic knee surgery. Methods: The records from January 2003 through April 2006 at a single academic orthopaedic surgery institution in Massachusetts were retrospectively reviewed to identify patients diagnosed with a meniscal tear and to determine whether surgery had been performed within six months after the diagnosis. Six categories of insurance were identified: private insurance, Workers' Compensation, Medicare, Medicaid, Uncompensated Care Pool, and self pay. A comparison of the proportions of insured and uninsured patients who underwent surgery was the primary outcome measure. Results: A total of 1127 patients were identified, and 446 (40%) of them underwent surgery within six months after an office visit. The patients with and without surgery had similar age and sex distributions. When patients were divided, according to their insurance status, into insured and uninsured groups, no significant difference was found in the rate of surgery (p = 0.23). However, subgroup analysis revealed significant differences among the six insurance categories. Logistic regression analysis showed that patients in the self-pay group had a lower rate of surgery than those with private insurance (odds ratio, 0.33; 95% confidence interval, 0.14 to 0.75; p = 0.008), whereas patients receiving Workers' Compensation (odds ratio, 1.93; 95% confidence interval, 1.05 to 3.55; p = 0.034) and those receiving Medicaid (odds ratio, 1.63; 95% confidence interval, 1.09 to 2.42; p = 0.016) had higher surgical rates than those with private insurance. Conclusions: The rate of elective arthroscopic knee surgery for meniscal tears varied significantly for some insurance categories at this single academic institution in Massachusetts. Further work is necessary to clarify the patient and surgeon factors influencing these disparities in clinical decision-making. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

UR - http://www.scopus.com/inward/record.url?scp=78049459480&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78049459480&partnerID=8YFLogxK

U2 - 10.2106/JBJS.I.01369

DO - 10.2106/JBJS.I.01369

M3 - Article

C2 - 20962196

AN - SCOPUS:78049459480

VL - 92

SP - 2452

EP - 2456

JO - Journal of Bone and Joint Surgery - American Volume

JF - Journal of Bone and Joint Surgery - American Volume

SN - 0021-9355

IS - 14

ER -