Olson Mara, Pandya Nirav
University of California, San Francisco, San Francisco, California, USA.
Orthop J Sports Med. 2021 Jan 22;9(1):2325967120979989. doi: 10.1177/2325967120979989. eCollection 2021 Jan.
Non- and underinsured individuals experience poor access to care and treatment delays. Meniscal injury is a common reason for surgical intervention in the pediatric population, and delays in care can lead to progression of the tear and other associated problems.
To investigate the impact of insurance status on access to care and severity of meniscal injury in the pediatric population.
Cohort study; Level of evidence, 3.
Enrolled in this study were 49 patients receiving care for a meniscal injury between 2016 and 2018 from a safety-net medical system that does not prioritize patients based on insurance status. The patients were stratified into those publicly insured and those privately insured. Access to care was measured as wait time to various points of care: initial injury to clinic, injury to magnetic resonance imaging (MRI), injury to surgery, clinic to MRI, clinic to surgery, and MRI to surgery. The severity of the meniscal tear was measured by findings at the time of arthroscopy, including the type of tear identified, surgery performed, and cartilage injury.
Publicly insured patients waited a mean 230 days longer (347 vs 117 days; < .01) to undergo surgery after injury compared with privately insured patients. The mean wait times in all categories except time from MRI to surgery were significantly longer for publicly insured patients, including injury to clinic (212 vs 73 days; < .01), injury to MRI (260 vs 28 days; < .001), injury to surgery (347 vs 117 days; < .01), clinic to MRI (36 vs 3.9 days; < .001), and clinic to surgery (136 vs 44 days; < .01). Neither increased wait times nor insurance status were associated with greater surgical repair rate, severe tear type, or cartilage injury.
Publicly insured pediatric patients waited significantly longer for a diagnosis of meniscal tear compared with privately insured patients, even in a safety-net setting. These delays were not associated with greater tear severity or cartilage changes. Providers in all models of care should recognize that insurance status and the socioeconomic factors it represents prevent publicly insured patients from timely diagnostic points of care and strive to minimize the resulting delayed return to normal activity as well as the potential long-term clinical effects thereof.
未参保和参保不足的个体在获得医疗服务和治疗延迟方面存在问题。半月板损伤是儿科人群进行手术干预的常见原因，而治疗延迟会导致撕裂进展及其他相关问题。
调查保险状况对儿科人群获得医疗服务及半月板损伤严重程度的影响。
队列研究；证据等级，3级。
本研究纳入了2016年至2018年间在一个不以保险状况对患者进行优先排序的安全网医疗系统中接受半月板损伤治疗的49例患者。患者被分为公共保险患者和私人保险患者。获得医疗服务的情况以到达不同医疗阶段的等待时间来衡量：从初始损伤到诊所、从损伤到磁共振成像（MRI）、从损伤到手术、从诊所到MRI、从诊所到手术以及从MRI到手术。半月板撕裂的严重程度通过关节镜检查时的发现来衡量，包括所确定的撕裂类型、进行的手术以及软骨损伤情况。
与私人保险患者相比，公共保险患者在受伤后等待手术的平均时间长230天（347天对117天；P<0.01）。除了从MRI到手术的时间外，公共保险患者在所有类别中的平均等待时间都显著更长，包括从损伤到诊所（212天对73天；P<0.01）、从损伤到MRI（260天对28天；P<0.001）、从损伤到手术（347天对117天；P<0.01）、从诊所到MRI（36天对3.9天；P<0.001）以及从诊所到手术（136天对44天；P<0.01）。等待时间的增加和保险状况均与更高的手术修复率、严重撕裂类型或软骨损伤无关。
即使在安全网环境下，与私人保险的儿科患者相比，公共保险的儿科患者在诊断半月板撕裂方面等待的时间也显著更长。这些延迟与更严重的撕裂程度或软骨变化无关。所有医疗模式下的医疗服务提供者都应认识到，保险状况及其所代表的社会经济因素使公共保险患者无法及时获得诊断性医疗服务，并应努力将由此导致的正常活动恢复延迟以及潜在的长期临床影响降至最低。
