Document Detail

Access to care for children with fractures.
MedLine Citation:
PMID:  20357590     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Earlier studies have found that children with fractures and PPO insurance have no access problems to orthopaedic care, but children with Medicaid have problems with access to orthopaedic care. METHODS: Fifty randomly selected orthopaedic offices in each of the 2 counties served by a children's hospital were telephoned to seek an appointment for a fictitious 10-year-old boy with a forearm fracture. Each office was called twice, 1 time reporting that the child had PPO insurance and 1 time that he was having Medicaid. In the second arm of the study, data including insurance status were prospectively collected on all patients with fractures seen in the emergency department of children's hospital. RESULTS: Of the 100 offices telephoned, 8 offices gave an appointment within 1 week to the child with Medicaid insurance. Thirty-six of the 100 offices gave an appointment within 1 week to the child with PPO insurance. For the 2210 pediatric fractures seen in the emergency department, the payer mix for patients presenting initially to our facility (1326 patients) was 41% Medicaid, 9% selfpay, and 50% commercial. For the patients presenting to our emergency department after being seen at an outside facility first (884 patients), the payer mix was 47% Medicaid, 13% self-pay, and 40% commercial. The percentages between these two groups were similar but did have a statistically significant difference (P=0.021). CONCLUSIONS: To the best of our knowledge, this is the first study that reports a majority (64/100) of orthopaedic offices in the region would not care for a child with a fracture regardless of insurance status. Consistent with earlier studies, children with Medicaid have less access to care. The similar insurance status of children sent to the emergency department from other facilities compared with those presenting directly suggests that children in this study are sent to a children's hospital for specialized care rather than for economic reasons. LEVEL OF EVIDENCE: Level II.
Christopher Iobst; Wesley King; Avi Baitner; Michael Tidwell; Stephen Swirsky; David L Skaggs
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of pediatric orthopedics     Volume:  30     ISSN:  1539-2570     ISO Abbreviation:  J Pediatr Orthop     Publication Date:    2010 Apr-May
Date Detail:
Created Date:  2010-04-01     Completed Date:  2010-06-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8109053     Medline TA:  J Pediatr Orthop     Country:  United States    
Other Details:
Languages:  eng     Pagination:  244-7     Citation Subset:  IM    
Miami Children's Hospital, Miami, FL 33155, USA.
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MeSH Terms
Emergency Service, Hospital / economics,  statistics & numerical data,  utilization
Fractures, Bone / economics,  therapy*
Health Services Accessibility / economics*,  statistics & numerical data
Hospitals, Pediatric / statistics & numerical data
Insurance Coverage / economics,  statistics & numerical data*
Insurance, Health / economics,  statistics & numerical data
Medicaid / economics,  statistics & numerical data
Orthopedic Procedures / economics*,  methods
Preferred Provider Organizations / statistics & numerical data
Prospective Studies
United States

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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