Faust Amanda Michelle, Dy Christopher J
Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid. St, Louis, MO, 63108, USA.
University of Missouri-School of Medicine, Columbia, MO, USA.
Curr Rev Musculoskelet Med. 2024 Nov;17(11):449-455. doi: 10.1007/s12178-024-09926-7. Epub 2024 Sep 2.
Healthcare disparities influence multiple dimensions of orthopaedic care including access, burden and incidence of disease, and outcome in varying populations. These disparities impact healthcare at both the micro and macro scale of the healthcare experience from individual patient-physician relationships to reimbursement rates across the United States. This article provides a review of how healthcare disparities contribute to the landscape of orthopaedic care and specifically highlights how disparities affect outpatient visits, discretionary and unplanned surgical care, and postoperative outcomes.
Current research demonstrates the widespread presence of healthcare disparities in the field of orthopaedics and gives both objective and subjective evidence confirming disparities' measurable influence. The disparities most highlighted by our review include differences in orthopaedic care based on insurance type and race. Currently disparities in orthopaedic care are deeply connected to patient insurance status and race. In the outpatient setting insurance significantly impacts access to care, travel burden, and utilization of services. The emergent setting is similarly influenced with measurable differences in lack of access to acute care, rates of inappropriate triage, and timeliness of care based on insurance status and race. Additionally, the postoperative period is not immune to disparities with likelihood of follow up, experience of catastrophic medical expenses, and postoperative outcomes also being affected. Addressing these disparities is a pressing need and may include solutions like wider expansion and acceptance of publicly funded insurance and the development of readily available and easily measurable metrics for healthcare equity and quality in vulnerable populations.
医疗保健差异影响骨科护理的多个方面，包括疾病的可及性、负担和发病率，以及不同人群的治疗结果。这些差异在医疗保健体验的微观和宏观层面都会对医疗保健产生影响，从个体患者与医生的关系到美国各地的报销率。本文综述了医疗保健差异如何影响骨科护理的格局，并特别强调了差异如何影响门诊就诊、选择性和非计划性手术护理以及术后结果。
当前研究表明，骨科领域广泛存在医疗保健差异，并提供了客观和主观证据，证实了差异具有可衡量的影响。我们的综述中最突出的差异包括基于保险类型和种族的骨科护理差异。目前，骨科护理中的差异与患者的保险状况和种族密切相关。在门诊环境中，保险显著影响医疗服务的可及性、出行负担和服务利用率。急诊环境也受到类似影响，在获得急性护理方面存在可衡量的差异、不适当分诊率以及基于保险状况和种族的护理及时性。此外，术后阶段也未能免受差异的影响，随访可能性、灾难性医疗费用经历以及术后结果也受到影响。解决这些差异是当务之急，可能包括扩大和接受公共资助保险等解决方案，以及为弱势群体制定易于获取和衡量的医疗保健公平性和质量指标。
