Kotha Vikas S, de Ruiter Brandon J, Nicoleau Marvin, Davidson Edward H
Department of Plastic Surgery, University Hospitals, Case Western Reserve University, Cleveland, Ohio.
Case Western Reserve University School of Medicine; Cleveland, Ohio.
Plast Reconstr Surg Glob Open. 2020 Nov 30;8(11):e3237. doi: 10.1097/GOX.0000000000003237. eCollection 2020 Nov.
Comprehensive craniomaxillofacial trauma care includes correcting functional deficits, addressing acquired deformities and appearance, and providing psychosocial support. The aim of this study was to characterize insurance coverage of surgical, medical, and psychosocial services indicated for longitudinal facial trauma care and highlight national discrepancies in policy.
A cross-sectional analysis of insurance coverage was performed for treatment of common functional, appearance, and psychosocial facial trauma sequelae. Policies were scored for coverage (3), case-by-case coverage (2), no mention (1), and exclusion (0). The sum of points determined coverage scores for functional sequelae, acquired-appearance sequelae, and psychosocial sequelae, the sum of which generated a Comprehensive Coverage Score.
Medicaid earned lower comprehensive coverage scores and lower coverage scores for psychosocial sequelae than did private insurance ( = 0.02, = 0.02). Medicaid CCSs were lowest in Oklahoma, Arkansas, and Missouri. Private insurance CCSs and psychosocial sequelae were highest in Colorado and Delaware, and lowest in Wisconsin. Coverage scores for functional sequelae and for acquired-appearance sequelae were similar for Medicaid and private policies. Medicaid coverage scores were higher in states that opted into Medicaid expansion ( = 0.04), states with Democrat governors ( = 0.02), states with mandated paid leave ( = 0.01), and states with >40% total population living >400% above federal poverty ( = 0.03). Medicaid comprehensive coverage scores and coverage scores for psychosocial sequelae were lower in southeastern states. Private insurance coverage scores for functional sequelae and for ASCSs were lower in the Midwest.
Insurance disparities in comprehensive craniomaxillofacial care coverage exist, particularly for psychosocial services. The disparities correlate with current state-level geopolitics. There is a uniform need to address national and state-specific differences in coverage from both Medicaid and private insurance policies.
全面的颅颌面创伤护理包括纠正功能缺陷、处理后天畸形和外观问题以及提供心理社会支持。本研究的目的是描述纵向面部创伤护理所需手术、医疗和心理社会服务的保险覆盖情况，并突出政策方面的全国差异。
对常见的功能、外观和心理社会面部创伤后遗症的治疗进行保险覆盖情况的横断面分析。对政策的覆盖情况进行评分（3分）、逐案覆盖情况（2分）、未提及（1分）和排除（0分）。这些分数的总和确定了功能后遗症、后天外观后遗症和心理社会后遗症的覆盖分数，其总和产生了一个综合覆盖分数。
与私人保险相比，医疗补助计划在综合覆盖分数以及心理社会后遗症的覆盖分数方面得分较低（P = 0.02，P = 0.02）。医疗补助计划的综合覆盖分数在俄克拉荷马州、阿肯色州和密苏里州最低。私人保险的综合覆盖分数和心理社会后遗症分数在科罗拉多州和特拉华州最高，在威斯康星州最低。医疗补助计划和私人保险政策在功能后遗症和后天外观后遗症的覆盖分数方面相似。在选择扩大医疗补助计划的州（P = 0.04）、有民主党州长的州（P = 0.02）、有强制带薪休假的州（P = 0.01）以及总人口中超过40%生活在联邦贫困线400%以上的州（P = 0.03），医疗补助计划的覆盖分数较高。东南部各州的医疗补助计划综合覆盖分数和心理社会后遗症覆盖分数较低。中西部地区私人保险在功能后遗症和后天外观后遗症的覆盖分数较低。
在全面的颅颌面护理覆盖方面存在保险差异，特别是在心理社会服务方面。这些差异与当前的州级地缘政治相关。统一需要解决医疗补助计划和私人保险政策在覆盖范围上的国家和州特定差异。
