Universal Health Insurance and its association with long term outcomes in Pediatric Trauma Patients

Sharma, Meesha; Schoenfeld, Andrew J.; Jiang, Wei; Chaudhary, Muhammad Ali; Ranjit, Anju; Zogg, Cheryl K.; Learn, Peter A.; Koehlmoos, Tracey Pérez; Haider, Adil H.

doi:10.1016/j.injury.2017.09.016

Cited by 20 publications

(10 citation statements)

References 31 publications

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“…However, well-recognized situations with other health conditions in addition to the trends in child injury deaths noted above raise the possibility that even when improvements in non-fatal injury outcomes and recovery trajectories are realized at the population level, there could be intractable or widening inequalities between sub-groups [ 2 , 12 ]. Factors ranging from increased exposure to injuries to unequal access to high-quality emergency trauma and rehabilitation care can place children in socially disadvantaged groups at increased risk of injury-related disability [ 13 , 14 , 15 , 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Disparities in Non-Fatal Health Outcomes in Pediatric General Trauma Studies

Ameratunga

Ramke

Jackson³

et al. 2017

IJERPH

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When prevention efforts fail, injured children require high-quality health services to support their recovery. Disparities in non-fatal injury outcomes, an indicator of health-care quality, have received minimal attention. We evaluated the extent to which general trauma follow-up studies published in the peer-reviewed scientific literature provide evidence of socially patterned inequities in health, functional or disability outcomes ≥4 weeks after childhood injuries. Using a systematic search, we identified 27 eligible cohort studies from 13 high-income countries. We examined the extent to which the reported health outcomes varied across the PROGRESS criteria: place of residence, race/ethnicity, occupation, gender/sex, religion, socio-economic status, and social capital. The available evidence on differential outcomes is limited as many studies were compromised by selection or retention biases that reduced the participation of children from demographic groups at increased risk of adverse outcomes, or the analyses mainly focused on variations in outcomes by sex. Given the limited research evidence, we recommend greater attention to systematic collection and reporting of non-fatal injury outcomes disaggregated by socio-demographic indicators in order to identify disparities where these exist and inform equity-focused interventions promoting the recovery of injured children.

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Section: Introductionmentioning

confidence: 99%

Disparities in Non-Fatal Health Outcomes in Pediatric General Trauma Studies

Ameratunga

Ramke

Jackson³

et al. 2017

IJERPH

View full text Add to dashboard Cite

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“…Second, the analysis of administrative data may not capture the nuances of the patient’s premorbid physical condition or of their treatment during their clinical care pathways. Inaccurate or “catch all” coding is a known limitation of administrative databases, and has been described in previous papers discussing TRICARE [31– 33]. Similarly, physician services could not be separated confidently into inpatient and outpatient care, and so were grouped independently.…”

Section: Discussionmentioning

confidence: 99%

Variation in expenditure for common, high cost surgical procedures in a working age population: implications for reimbursement reform

Wynn-Jones

Koehlmoos

Tompkins

et al. 2019

BMC Health Serv Res

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BackgroundIn the move toward value-based care, bundled payments are believed to reduce waste and improve coordination. Some commercial insurers have addressed this through the use of bundled payment, the provision of one fee for all care associated with a given index procedure. This system was pioneered by Medicare, using a population generally over 65 years of age, and despite its adoption by mainstream insurers, little is known of bundled payments’ ability to reduce variation or cost in a working-age population. This study uses a universally-insured, nationally-representative population of adults aged 18–65 to examine the effect of bundled payments for five high-cost surgical procedures which are known to vary widely in Medicare reimbursement: hip replacement, knee replacement, coronary artery bypass grafting (CABG), lumbar spinal fusion, and colectomy.MethodsFive procedures conducted on adults aged 18–65 were identified from the TRICARE database from 2011 to 2014. A 90-day period from index procedure was used to determine episodes of associated post-acute care. Data was sorted by Zip code into hospital referral regions (HRR). Payments were determined from TRICARE reimbursement records, they were subsequently price standardized and adjusted for patient and surgical characteristics. Variation was assessed by stratifying the HRR into quintiles by spending for each index procedure.ResultsAfter adjusting for case mix, significant inter-quintile variation was observed for all procedures, with knee replacement showing the greatest variation in both index surgery (107%) and total cost of care (75%). Readmission was a driver of variation for colectomy and CABG, with absolute cost variation of $17,257 and $13,289 respectively. Other post-acute care spending was low overall (≤$1606, for CABG).ConclusionsThis study demonstrates significant regional variation in total spending for these procedures, but much lower spending for post-acute care than previously demonstrated by similar procedures in Medicare. Targeting post-acute care spending, a common approach taken by providers in bundled payment arrangements with Medicare, may be less fruitful in working aged populations.

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“…Although the TRICARE system cannot adequately serve as a proxy for the general population given that military families live in a specific and controlled environment, comparing disparities within this system to the US health care system may still offer some insight into future strategies to minimize disparities. When evaluating complications, readmissions, and outpatient health care utilization over 90 days postdischarge in children with a primary trauma diagnosis, Sharma et al 44 found no statistically significant disparities between Black and White children. This differs from many of the studies discussed above, where insurance status and race have a statistically significant impact on postoperative outcomes, suggesting that equal access to insurance and postdischarge care may mitigate disparities within the health care system.…”

Section: Addressing Disparitiesmentioning

confidence: 99%

What’s New in Pediatric Orthopaedic Health Care Disparities?

Arant

Modest

Gil

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Health care disparities are prevalent within pediatric orthopaedics in the United States. Social determinants of health, such as income, race, social deprivation, place of residence, and parental involvement, all play a role in unequal access to care and disparate outcomes. Although there has been some effort to promote health equity both within pediatric orthopaedics and the US health care system altogether, disparities persist. In this review, we aim to identify major sources of inequality and propose solutions to achieve equitable care in the future. Methods: We searched the PubMed database for papers addressing disparities in pediatric orthopaedics published between 2016 and 2021, yielding 283 papers. Results: A total of 36 papers were selected for review based upon new findings. Insurance status, race, and social deprivation are directly linked to poorer access to care, often resulting in a delay in presentation, time to diagnostic imaging, and surgery. Although these disparities pervade various conditions within pediatric orthopaedics, they have most frequently been described in anterior cruciate ligament/meniscal repairs, tibial spine fractures, adolescent idiopathic scoliosis, and upper extremity conditions. Treatment outcomes also differ based on insurance status and socioeconomic status. Several studies demonstrated longer hospital stays and higher complication rates in Black patients versus White patients. Patients with public insurance were also found to have worse pain and function scores, longer recoveries, and lower post-treatment follow-up rates. These disparate outcomes are, in part, a response to delayed access to care. Conclusions: Greater attention paid to health care disparities over the past several years has enabled progress toward achieving equitable pediatric orthopaedic care. However, delays in access to pediatric orthopaedic care among uninsured/publicly insured, and/or socially deprived individuals remain and consequently, so do differences in post-treatment outcomes. Reducing barriers to care, such as insurance status, transportation and health literacy, and promoting education among patients and parents, could help health care access become more equitable.

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Universal Health Insurance and its association with long term outcomes in Pediatric Trauma Patients

Cited by 20 publications

References 31 publications

Disparities in Non-Fatal Health Outcomes in Pediatric General Trauma Studies

Disparities in Non-Fatal Health Outcomes in Pediatric General Trauma Studies

Variation in expenditure for common, high cost surgical procedures in a working age population: implications for reimbursement reform

What’s New in Pediatric Orthopaedic Health Care Disparities?

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