Disparity in access to orthopedic surgery between public and private healthcare insurance: a nationwide population-based study.

BACKGROUND

This study aimed to evaluate if access to orthopedic surgery differs by healthcare coverage in a country with a dual healthcare system adjusted by age, sex, and urgent and elective conditions. We hypothesize that differential access would exist according to the type of healthcare coverage. This difference would accentuate when analyzing access to elective orthopedic surgery.

METHODS

A cross-sectional, population-based design was used to investigate orthopedic surgery rates in Chile in 2018. The rates of orthopedic surgeries provided under the private and public healthcare systems were calculated per 1,000 inhabitants based on data collected from the Hospital Discharge Registry provided by the Chilean Ministry of Health. ICD-10 diagnoses were classified as urgent or elective, categories into which the public/private surgery rates were also sorted.

RESULTS

The overall rate of orthopedic surgery was 7.54 per 1000 inhabitants in 2018. Patients covered under private insurance had an orthopedic surgery rate 2.23 times higher than patients within the public system (p-value < 0.001). This difference became more accentuated when sorting by elective surgeries, with private healthcare having a rate 2.97 times higher than public healthcare (p-value < 0.001). In the multivariate analysis, significant differences were observed in the rates of orthopedic surgery, being higher in the private system, elective surgeries, and older adults. No significant differences were observed according to sex (p-value 0.270).

CONCLUSIONS

In Chile, access disparity to orthopedic surgical care existed between private and public healthcare systems, elective surgeries, and older age groups. Disparity in access became greater when separately analyzing the rates of elective and urgent orthopedic surgeries.

LEVEL OF EVIDENCE

III.