From the Department of Orthopedics, University of Alabama at Birmingham, Birmingham.
South Med J. 2021 Jan;114(1):35-40. doi: 10.14423/SMJ.0000000000001198.
Studies have shown that patients enrolled in Medicaid have difficulty obtaining access to care compared with patients with private insurance. Whether variables such as geographic location, state expansion versus nonexpansion, and private versus academic affiliation affect access to care among foot and ankle surgery patients enrolled in Medicaid has not been previously established. The purpose of this study was to assess the differences in access to care between patients who are privately insured and those with Medicaid in need of foot and ankle consultation. Secondary objectives include assessment of whether access to care for foot and ankle patients with Medicaid differs between those with acute and chronic conditions, Medicaid expanded and unexpanded states, geographic regions within the United States, and academic versus private practices.
Twenty providers from each of five Medicaid-expanded and five nonexpanded states in different US geographic regions were randomly chosen via the American Orthopaedic Foot & Ankle Society directory. One investigator contacted each office requesting the earliest available appointment for their fictitious relative's acute Achilles tendon rupture or hallux valgus. Investigator insurance was stated to be Medicaid for half of the telephone calls and Blue Cross Blue Shield (BCBS) for the other half. Appointment success rate and average time to appointment were compared between private insurance and Medicaid. Results were further compared across geographic regions, between private and academic practices, and between urgent acute injury (Achilles rupture) and chronic nonurgent injury (hallux valgus).
Appointments were successful for all 100 (100%) calls made with BCBS as the insurer, in comparison to 73 of 100 calls (73%) with Medicaid ( < 0.001). Both acute and chronic injury had significantly higher success rates with BCBS than Medicaid ( < 0.001). The appointment success rate was significantly lower with Medicaid than with BCBS ( ≤ 0.01) in all of the geographic regions. The success rate with Medicaid (66.7%) was significantly lower than with BCBS (100.0%, < 0.001) for private practice offices, but not for academic practices.
Patients with Medicaid experience fewer options when obtaining appointments for common nonemergent foot and ankle problems and may experience less difficulty scheduling appointments at academic rather than private institutions. The medical community should continue to seek and identify potential interventions which can improve access to orthopedic care for all patients and increase the visibility of practices that accept Medicaid.
研究表明，与拥有私人保险的患者相比，参加医疗补助计划的患者在获得医疗方面存在困难。但是，地理位置、州扩张与不扩张、私人与学术附属机构等变量是否会影响参加医疗补助计划的足踝外科患者的获得医疗服务，这一点尚未得到证实。本研究的目的是评估在需要足踝咨询的患者中，私人保险患者和医疗补助患者在获得医疗服务方面的差异。次要目标包括评估在患有急性和慢性疾病、医疗补助扩张和不扩张的州、美国不同地理区域以及学术和私人实践的患者中，医疗补助患者获得医疗服务的情况是否存在差异。
通过美国矫形足踝协会名录，从五个医疗补助计划扩张州和五个不扩张州的每个州随机选择了 20 名提供者。一位调查员通过电话联系每家诊所，为他们虚构的亲属的急性跟腱断裂或拇囊炎预约最早的就诊时间。在一半的电话中，调查员的保险被声明为医疗补助，而在另一半电话中则为蓝十字蓝盾（BCBS）。比较私人保险和医疗补助在预约成功率和平均预约时间方面的差异。结果根据地理位置、私人和学术实践以及急性（跟腱断裂）和慢性（拇囊炎）非紧急损伤进行了进一步比较。
使用 BCBS 作为保险时，所有 100 次（100%）电话预约均成功，而使用医疗补助时，只有 73 次（73%）电话预约成功（<0.001）。与医疗补助相比，无论是急性还是慢性损伤，BCBS 的预约成功率均显著更高（<0.001）。在所有地理区域，医疗补助的预约成功率均显著低于 BCBS（≤0.01）。与 BCBS（100.0%，<0.001）相比，私人实践的医疗补助预约成功率（66.7%）显著更低，但学术实践并非如此。
患有医疗补助的患者在获得常见非紧急足踝问题的预约时选择较少，并且在学术机构而非私人机构预约可能会遇到较少的困难。医疗界应继续寻找并确定潜在的干预措施，以改善所有患者获得骨科护理的机会，并提高接受医疗补助的实践的知名度。
