Martin Christopher T, Callaghan John J, Liu Steve S, Gao Yubo, Johnston Richard C
Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, 01029 JPP, Iowa City, IA 52242, USA.
Orthopedics. 2012 Dec;35(12):e1798-803. doi: 10.3928/01477447-20121120-27.
Equity in health care has become a focal point of debate. However, the disparity between insurance payer types in total joint arthroplasty is poorly defined. The authors identified 1312 consecutive patients who underwent elective primary total hip or knee arthroplasty with available preoperative Short Form 36 and Western Ontario and McMaster University Osteoarthritis Index surveys and stratified them into groups based on insurance type (Iowa Care [a state-run insurance program for patients who are indigent], Medicare, Medicaid, or private insurance) to compare demographics, access to care, and functional data. Significance was a P value less than .05 after a Turkey-Kramer adjustment for multiple comparisons. A multivariate analysis identified independent predictors of Short Form 36 and Western Ontario and McMaster University Osteoarthritis Index preoperative functional status. Few differences existed between patients with Iowa Care and Medicaid, but both groups had significantly lower Short Form 36 and Western Ontario and McMaster University Osteoarthritis Index scores across every category compared with patients with Medicare or private insurance (P<.05 for each comparison). In addition, patients with Iowa Care and Medicaid had a higher incidence of current smoking and higher mean body mass index and traveled an average of 29 to 30 miles farther for access to care (P<.05 for each comparison). Payer type was an independent predictor of preoperative Short Form 36 and Western Ontario and McMaster University Osteoarthritis Index functional scores in the multivariate analysis (P<.02). Significant differences exist between payer types in total joint arthroplasty. Further research is necessary to better inform health policy decisions.
医疗保健中的公平性已成为辩论的焦点。然而，全关节置换术中不同保险支付类型之间的差异界定不清。作者确定了1312例连续接受择期初次全髋关节或膝关节置换术的患者，这些患者术前有可用的简短健康调查问卷（Short Form 36）和西安大略和麦克马斯特大学骨关节炎指数（Western Ontario and McMaster University Osteoarthritis Index）调查结果，并根据保险类型（爱荷华医疗计划[一项为贫困患者提供的州立保险计划]、医疗保险、医疗补助或私人保险）将他们分组，以比较人口统计学、医疗服务可及性和功能数据。经Turkey-Kramer多重比较调整后，显著性水平为P值小于0.05。多变量分析确定了简短健康调查问卷和西安大略和麦克马斯特大学骨关节炎指数术前功能状态的独立预测因素。爱荷华医疗计划患者和医疗补助患者之间差异不大，但与医疗保险或私人保险患者相比，两组在各个类别中的简短健康调查问卷和西安大略和麦克马斯特大学骨关节炎指数评分均显著更低（每次比较P<0.05）。此外，爱荷华医疗计划患者和医疗补助患者当前吸烟的发生率更高，平均体重指数更高，就医平均出行距离远29至30英里（每次比较P<0.05）。在多变量分析中，支付类型是术前简短健康调查问卷和西安大略和麦克马斯特大学骨关节炎指数功能评分的独立预测因素（P<0.02）。全关节置换术中不同支付类型之间存在显著差异。需要进一步研究以更好地为卫生政策决策提供依据。
