Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
J Bone Joint Surg Am. 2010 Oct 20;92(14):2452-6. doi: 10.2106/JBJS.I.01369.
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.
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.
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.
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.
未参保和参保不足的美国人在获得医疗服务方面面临障碍。本研究的目的是描述保险状况对半月板撕裂患者是否进行择期膝关节镜手术的影响。
回顾性分析 2003 年 1 月至 2006 年 4 月在马萨诸塞州一家学术骨科机构的病历，以确定诊断为半月板撕裂的患者，并确定诊断后 6 个月内是否进行了手术。确定了 6 种保险类型：私人保险、工人赔偿、医疗保险、医疗补助、无赔偿者医疗池和自费。主要观察指标为比较参保和未参保患者接受手术的比例。
共确定了 1127 例患者，其中 446 例（40%）在门诊后 6 个月内接受了手术。接受手术和未接受手术的患者年龄和性别分布相似。当根据保险状况将患者分为参保组和未参保组时，手术率无显著差异（p = 0.23）。然而，亚组分析显示 6 种保险类别之间存在显著差异。Logistic 回归分析显示，自费组手术率低于私人保险组（比值比，0.33；95%置信区间，0.14 至 0.75；p = 0.008），而接受工人赔偿（比值比，1.93；95%置信区间，1.05 至 3.55；p = 0.034）和接受医疗补助（比值比，1.63；95%置信区间，1.09 至 2.42；p = 0.016）的患者手术率高于私人保险组。
在马萨诸塞州的这家学术机构，对于某些保险类别，半月板撕裂的择期膝关节镜手术率差异显著。需要进一步研究以阐明影响这些临床决策差异的患者和外科医生因素。
