Insurance status affects postoperative morbidity and complication rate after shoulder arthroplasty

Medicaid payer status is associated with increased mortality and morbidity after inpatient shoulder arthroplasty: a multistate analysis, 2007–2014

“…Overall mortality was not found to be associated with insurance status. While the overall complication rates in our study were lower for privately insured patients as well as Medicaid patients (4.5% and 6.7%, respectively), Li et al 5 included any adverse surgical event as a complication, which may explain their overall higher complication rate 5. Additionally, Li et al 5 conflated Medicaid enrollees with being uninsured; we differentiated between these two groups.…”

“…Li et al ,5 in a retrospective study of 103 290 patients who underwent shoulder arthroplasty from 2004 to 2011, found that patients who had Medicare, Medicaid, or no insurance had significantly higher rates of medical and surgical complications than matched controls with private insurance 5. Privately insured patients had an overall complication rate of 10.5%, which was significantly lower than complication rates of 16.9% and 20.3% for Medicaid/uninsured patients and Medicare patients, respectively.…”

Scratching the Surface: Itching for Evidence to Reduce Surgical Health Disparities in Total Shoulder Arthroplasty

“…Despite the strengths of the national database, the current study's findings must be interpreted with caution, as others using the NIS have done previously 5,7,8 . The extent to which confounding by unmeasured factors could have been at play must be considered.…”

“…This publicly available database with all-payer inpatient care data reduces the likelihood of selection bias that may occur in a single or multisite retrospective design 6 . The authors combined more than 15 years of data to further examine surgical complications including transfusion and revision associated with TSA, thus extending previous research using the same data source 7,8 . Most importantly, the NIS allowed the authors to evaluate the extent to which one of the key socioeconomic characteristics, the median household income, was associated with post-TSA outcomes.…”

Reforming the National Health Insurance Fund for better surgical care financing

“…If the patient is unable to mobilize these resources using outof-pocket payment, access to surgery will be limited or delayed. Unaffordable surgical care leads to late presentation and inability to pay for complete care, including post-operative services that are needed to make a complete recovery (7). Low-income populations are the most affected by the cost of care (8).…”