Park Anna L, Singh Dhillon Pardeep, Pandya Nirav K
School of Medicine, University of California, San Francisco, San Francisco, California, USA.
Department of Pediatric Orthopaedic Surgery, University of California, San Francisco, Benioff Children's Hospital Oakland, Oakland, California, USA.
Orthop J Sports Med. 2024 Sep 4;12(9):23259671241270310. doi: 10.1177/23259671241270310. eCollection 2024 Sep.
Patients with public insurance (PUBs) face more difficulty obtaining orthopaedic appointments and have longer wait times than privately insured patients (PVTs). These delays are associated with greater injury severity at the time of surgery, which affects sports injuries such as anterior cruciate ligament tears where early surgical stabilization leads to better outcomes. Additionally, previous evidence showed that patients with limited English proficiency often must rely on informal translation services, such as family members or friends, to communicate with their orthopaedic surgeons, which may represent a disparity in the care provided.
It was hypothesized that PUBs would be less likely to obtain an appointment compared with PVTs and that most providers would not offer professional translation services to Spanish-speaking patients.
Cross-sectional study.
The authors called 50 randomly selected orthopaedic surgeons' offices in California specializing in sports medicine to request an appointment. Each office was called 4 times in random order for the hypothetical patient having either private or public insurance and speaking either Spanish or English.
The hypothetical PUB had significantly decreased access to an appointment (19% of offices offered an appointment) when compared to the PVT (73.8% offered an appointment). Independent private practice (IPP) offices were less likely to accept public insurance (13.3%) compared with offices at academic medical centers (57.1%). There was no difference in access to an appointment for the Spanish- versus English-speaking patient. Translation services were offered at 73.8% of the orthopaedic offices.
Overall, the data illustrated disparities in access to pediatric orthopaedic care for PUBs compared to those with private insurance. Disparities were most prominent in IPP settings, which were less likely than academic offices to accept public insurance. Additionally, it was found that 73.8% of the offices the authors contacted offered Spanish translation services. Interventions should focus on increasing acceptance of public insurance and translation services in IPP settings. Future studies should expand this analysis to other languages and investigate the potential impacts of language on the quality of care provided.
与私人保险患者（PVTs）相比，公共保险患者（PUBs）在获得骨科预约方面面临更多困难，等待时间更长。这些延迟与手术时更严重的损伤相关，这会影响诸如前交叉韧带撕裂等运动损伤，早期手术稳定化会带来更好的结果。此外，先前的证据表明，英语水平有限的患者通常必须依靠非正式翻译服务，如家庭成员或朋友，来与骨科医生沟通，这可能代表了所提供护理方面的差异。
假设与PVTs相比，PUBs获得预约的可能性较小，并且大多数医疗机构不会为讲西班牙语的患者提供专业翻译服务。
横断面研究。
作者致电加利福尼亚州50家随机选择的专门从事运动医学的骨科医生办公室预约。每个办公室以随机顺序被呼叫4次，为假设的患者预约，该患者分别有私人保险或公共保险，且讲西班牙语或英语。
与PVTs（73.8%提供预约）相比，假设的PUB获得预约的机会显著减少（19%的办公室提供预约）。独立私人执业（IPP）办公室比学术医疗中心的办公室（57.1%）更不可能接受公共保险（13.3%）。讲西班牙语的患者和讲英语的患者在获得预约方面没有差异。73.8%的骨科办公室提供翻译服务。
总体而言，数据表明与私人保险患者相比，PUBs在获得小儿骨科护理方面存在差异。差异在IPP机构中最为突出，IPP机构比学术机构更不可能接受公共保险。此外，作者联系的办公室中有73.8%提供西班牙语翻译服务。干预措施应侧重于提高IPP机构对公共保险和翻译服务的接受度。未来的研究应将此分析扩展到其他语言，并调查语言对所提供护理质量的潜在影响。
