Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA 02115, USA.
Clin Orthop Relat Res. 2012 Jul;470(7):1917-24. doi: 10.1007/s11999-012-2305-8. Epub 2012 Mar 27.
Before the US Patient Protection and Affordable Care Act of 2010, there were documented insurance-based disparities in access to orthopaedic surgeons and care of orthopaedic conditions. While Massachusetts passed healthcare reform in 2007 with many similar provisions, it is unknown whether the disparities were present during the period of the law's enactment.
QUESTIONS/PURPOSES: We asked whether differences in rates of surgery between patients with novel government-subsidized healthcare plans and other forms of insurance, and between uninsured and insured patients, were similar after institution of the Massachusetts reform laws.
We identified 7577 patients diagnosed with upper extremity injuries between January 1, 2007 and October 1, 2010. From an institutional administrative database, we extracted demographics, insurance status, and plan of care. Insurance categories included government-subsidized healthcare plan (Commonwealth Care), private insurance, workers compensation, military-related (TriCare), Medicare, Medicaid (MassHealth), non-Commonwealth Care, and other insured and uninsured. After adjusting for age, gender, and diagnosis, we compared the proportions of patients who underwent elective surgery.
Of 7577 patients, 1685 (22%) underwent elective upper extremity surgery. The adjusted rates of surgery were similar across most insurance categories, with higher rates in the workers compensation and TriCare categories compared with Commonwealth Care. Uninsured patients were as likely to undergo surgery as insured patients.
In a population with near-universal health insurance, a government-run health insurance exchange, and novel, government-subsidized, managed care plans, we found few insurance-based differences in rates of elective upper extremity orthopaedic surgery in a cohort of patients after healthcare reform.
2010 年美国《患者保护与平价医疗法案》（Patient Protection and Affordable Care Act）颁布之前，在获得骨科医生的诊治和治疗骨科疾病方面，有记录表明保险存在差异。虽然马萨诸塞州在 2007 年通过了具有许多类似规定的医疗改革，但尚不清楚在该法律颁布期间是否存在差异。
问题/目的：我们询问了在马萨诸塞州改革法实施后，接受新型政府补贴医疗保险计划和其他形式保险的患者之间，以及未参保和已参保患者之间，手术率的差异是否相似。
我们确定了 7577 例在 2007 年 1 月 1 日至 2010 年 10 月 1 日期间被诊断为上肢损伤的患者。从机构行政数据库中，我们提取了人口统计学、保险状况和治疗计划。保险类别包括政府补贴医疗保险计划（Commonwealth Care）、私人保险、工人补偿、军事相关（TriCare）、医疗保险（Medicare）、医疗补助（MassHealth）、非 Commonwealth Care 以及其他有保险和无保险的患者。在调整年龄、性别和诊断后，我们比较了接受择期手术的患者比例。
在 7577 例患者中，有 1685 例（22%）接受了择期上肢手术。在大多数保险类别中，手术率相似，工人补偿和 TriCare 类别中的手术率高于 Commonwealth Care。未参保患者与参保患者接受手术的可能性相同。
在一个拥有近乎全民医疗保险、政府运营的医疗保险交易所和新型政府补贴的管理式医疗保健计划的人群中，我们发现医疗改革后，患者群体中选择进行上肢骨科手术的保险差异很小。
