Association of Insurance Status With Treatment Delays for Pediatric and Adolescent Patients Undergoing Surgery for Patellar Instability

Abstract

Background: Health care disparities have been highlighted in pediatric sports medicine, but the association between insurance status and delayed care for patients undergoing surgery for patellar instability has not been defined. Purpose: To determine whether there is an association between insurance status and delays in care in pediatric and adolescent patients undergoing surgery for patellar instability. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective case series at a safety-net tertiary referral center of pediatric and adolescent patients undergoing surgical treatment for patellar instability. Insurance status was classified as public or private. We calculated the times from injury to clinical evaluation, injury to magnetic resonance imaging (MRI), injury to surgery, clinical evaluation to MRI, and clinical evaluation to surgery. Comparisons were made between insurance groups. Results: Included were 78 patients (38 public, 40 private insurance) who underwent surgery for patellar instability. The public insurance group was older ( P = .019), with a lower proportion of White patients (15.8% vs 52.5%; P = .0005), higher proportion with Hispanic ethnicity (55.3% vs 15.0%; P = .0001), and higher proportion of Spanish-speaking patients (21.1% vs 2.5%; P = .007). Publicly insured patients had longer times from initial injury to clinical evaluation (466 vs 77 days; P = .002), MRI (466 vs 82 days; P = .003), and surgery (695 vs 153 days; P = .0003), as well as a longer time from clinical evaluation to surgery (226 vs 73 days; P = .002). Multivariable models confirmed insurance status as an independent predictor in each of the identified delays. Conclusion: Significant delays were seen for pediatric and adolescent patients with patellar instability and public insurance (approximately 6 times longer to clinical evaluation, more than 5.5 times longer to obtain MRI, and 4.5 times longer to surgery) relative to injured patients with private insurance. Even after adjusting for delays to clinical evaluation, publicly insured patients had a delay from clinic to surgery that was triple that of privately insured patients.

Focus areas and methodological characteristics of North American-based health disparity research in sports medicine: a scoping review

“…The included research articles were classified into five mutually exclusive primary focus areas during the data extraction phase: (1) access to and participation in sports , (2) access to SEM care , (3) health-related outcomes in SEM , (4) study methodology and (5) provider representation in SEM (table 1, online supplemental table S4). Most included studies were related to access to and participation in sports (n=45, 44%),17–61 followed by access to SEM care (n=28, 27%),62–89 health-related outcomes in SEM (n=24, 23%),90–113 provider representation in SEM (n=5, 5%)114–118 and methodology (n=1, 1%) 119…”

“…Figure 2 shows the various combinations of potential causes of health disparities that were assessed and the number of articles that addressed these combinations. The combination of race/ethnicity and sex was the largest combination, with 13 articles looking at both characteristics (and in some cases additional characteristics) in relation to health disparities 21 32 35 62 95 97 103 105 107 108 115 116 118…”

“…Within the access to SEM care domain, insurance (n=11 articles)62 64 66 67 74 77 78 82 88 89 and SES (n=7)65 68 72 73 79 80 82 were most represented (figure 3B), while other areas, such as intellectual ability, body composition and education level, were not studied at all. Additionally, only one article81 was identified that considered physical ability as it relates to access to sports medicine care.…”

Home ownership, full-time employment, and other markers of higher socioeconomic status are predictive of shorter time to initial evaluation, shorter time to surgery, and superior postoperative outcomes among lateral patellar instability patients undergoing medial patellofemoral ligament reconstruction

“…In the setting of patellar instability and operative treatment with MPFLR, certain socioeconomic characteristics may be of benefit or an obstacle to early recognition of patellar instability and seeking appropriate treatment for the condition. Prior analyses by Li et al and Allahabadi et al have found that race and insurance status may be significant predictors of access to surgical care, timing of initial evaluation and surgery, and cost of treatment among patellar instability patients [ 1 , 16 ]. This is especially important given that chronicity of instability symptoms has been associated with increased likelihood of sequelae such as chondral lesions, chronic pain, and early osteoarthrosis [ 5 , 19 ].…”

Concerns About the Evaluation of Diversity in “Current Perceptions of Diversity Among Head Team Physicians and Head Athletic Trainers”: Response

“…We are subject to the implicit and explicit biases of the patients and athletes we take care of every day based on the color of our skin. We take issues of diversity, equity, and inclusion very seriously, not only from an academic standpoint 1 , 2 , 5 , 6 , 8 , 10 , 11 , 14 – 16 but also from a personal standpoint. Patients view us, however, through the color of our skin, making assumptions about us regardless of how we self-report/self-identify.…”