From the Department of Orthopaedic Surgery, University of Alabama at Birmingham Birmingham.
the Hughston Clinic Foundation, Columbus, Georgia.
South Med J. 2023 Mar;116(3):270-273. doi: 10.14423/SMJ.0000000000001523.
Patients with private healthcare plans often defer nonemergent or elective procedures toward the end of the year once they have met their deductible. No previous studies have evaluated how insurance status and hospital setting may affect surgical timing for upper extremity procedures. Our study aimed to evaluate the influence of insurance and hospital setting on end-of-the-year surgical cases for elective carpometacarpal (CMC) arthroplasty, carpal tunnel, cubital tunnel, and trigger finger release, and nonelective distal radius fixation.
Insurance provider and surgical dates were gathered from two institutions' electronic medical records (one university, one physician-owned hospital) for those undergoing CMC arthroplasty, carpal tunnel release, cubital tunnel release, trigger finger release, and distal radius fixation from January 2010 to December 2019. Dates were converted into corresponding fiscal quarters (Q1-Q4). Using the Poisson exact test, comparisons were made between the case volume rate of Q1-Q3 and Q4 for private insurance and then for public insurance.
Overall, case counts were greater in Q4 than the rest of the year at both institutions. There was a significantly greater proportion of privately insured patients undergoing hand and upper extremity surgery at the physician-owned hospital than the university center (physician owned: 69.7%, university: 50.3%; 0.001). Privately insured patients underwent CMC arthroplasty and carpal tunnel release at a significantly greater rate in Q4 compared with Q1-Q3 for both institutions. Publicly insured patients did not experience an increase in carpal tunnel releases during the same period at both institutions.
Privately insured patients underwent elective CMC arthroplasty and carpal tunnel release procedures in Q4 at a significantly greater rate than publicly insured patients. This finding suggests private insurance status, and potentially deductibles, influence surgical decision making and timing. Further work is needed to evaluate the impact of deductibles on surgical planning and the financial and medical impact of delaying elective surgeries.
一旦患者达到自付额上限，他们往往会将私人医疗保险计划下的非紧急或选择性手术推迟到年底。此前尚无研究评估保险状况和医院环境如何影响上肢手术的时间安排。本研究旨在评估保险和医院环境对择期腕掌（CMC）关节成形术、腕管松解术、肘管松解术和扳机指松解术以及非选择性桡骨远端固定术的年末手术病例的影响。
从两家机构（一所大学和一家医生所有的医院）的电子病历中收集了 CMC 关节成形术、腕管松解术、肘管松解术、扳机指松解术和桡骨远端固定术患者的保险提供商和手术日期。将日期转换为相应的财政季度（Q1-Q4）。使用泊松精确检验，比较了私人保险和公共保险患者 Q1-Q3 和 Q4 的病例量率。
总体而言，两家医院 Q4 的病例数均高于当年其他季度。在医生所有的医院接受手部和上肢手术的私人保险患者比例明显高于大学中心（医生所有：69.7%，大学：50.3%；0.001）。与 Q1-Q3 相比，两家医院的私人保险患者在 Q4 进行 CMC 关节成形术和腕管松解术的比例显著更高。同期，两家医院的公共保险患者行腕管松解术的人数并未增加。
与公共保险患者相比，私人保险患者在 Q4 进行择期 CMC 关节成形术和腕管松解术的比例显著更高。这一发现表明私人保险状况，可能还有自付额，会影响手术决策和时间安排。需要进一步研究自付额对手术计划的影响以及延迟选择性手术的财务和医疗影响。
