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. 2020 Aug;4(8):e20.00111.
doi: 10.5435/JAAOSGlobal-D-20-00111.

Inequalities in Pediatric Fracture Care Timeline Based on Insurance Type

Brock T Kitchen  1 , Samuel S Ornell, Kush N Shah, William Pipkin, Natalie L Tips, Grant D Hogue
Affiliations

Inequalities in Pediatric Fracture Care Timeline Based on Insurance Type

Brock T Kitchen et al. J Am Acad Orthop Surg Glob Res Rev. 2020 Aug.

Abstract

Introduction: Socioeconomic and insurance status are often linked with limited access to health care. Despite several government-funded projects aimed at curtailing these barriers, pediatric orthopaedic patients continue to experience delays in receiving timely care for fracture treatments. This delay has been well-identified within the orthopaedic literature but, to our knowledge, has never been characterized based on timeline. Thus, the goal of this study is to evaluate the role of ethnicity, socioeconomic status, and insurance type on the timeline of pediatric patients to obtain orthopaedic care within our community.

Methods: Pediatric patients presenting to our clinic for the treatment of one of 21 most common fractures were included. Patient demographics and the timeline of patient care were collected by retrospective chart review.

Results: Government-funded insurance accounted for 60.6% of the 413 patients. These patients experienced significant (P < 0.001) delays in access to care when compared with commercial insurance patients; the time between injury and referral as well as the overall time from injury to orthopaedic evaluation was 2.8 and twofold greater at 4.4 days and 9.2 days, respectively. A strong correlation was established between income levels and insurance type.

Discussion: Pediatric patients with a lower socioeconomic status are more likely to rely on government-funded insurance and experience delays in fracture evaluation.

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Conflict of interest statement

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Kitchen, Ornell, Dr. Shah, Dr. Pipkin, Tips, and Dr. Hogue.

Figures

Figure 1
Figure 1
Graph showing the distribution of delay experienced by commercial and government-funded insurance patients: Time between (A) injury and orthopaedic evaluation and (B) injury and referral.
Figure 2
Figure 2
Graph showing the average delay experienced by patients with commercial insurance, government-funded insurance, or self-pay between (A) injury and orthopaedic evaluation, (B) injury and referral, and (C) referral and orthopaedic evaluation. Error bars represent standard error of the mean. ***P ≤ 0.001; ****P ≤ 0.0001.
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