Utilization of Elective Hip and Knee Arthroplasty by Age and Payer

Abstract

Elective joint arthroplasty improves the quality of life for patients with severe arthritis. In the United States, utilization of services varies with insurance status. We asked the following questions: (1) Is there an increase in the utilization of elective hip and knee arthroplasty after age 65? (2) Does the difference in utilization between the insured and general populations decrease at age 65 (the age at which Medicare provides near universal coverage)? (3) Does Medicare become the primary payer of elective hip and knee arthroplasty after the age of 65? We used the National Inpatient Sample to identify patients and payers of elective hip and knee arthroplasties by age. We analyzed these data using regression models. At age 65, there was an upward shift in the incidence of arthroplasties in the general and the insured populations and the difference between these two populations decreased. Medicare was the primary payer for the majority of arthroplasties after age 65. We conclude at age 65 the following occurs: (1) utilization of elective joint arthroplasty increases; (2) the difference between the insured population and the general population decreases; and (3) Medicare becomes the primary payer of arthroplasties.

Epidemiology of adolescent total knee arthroplasty patient and a comparison to adult patient demographics

“…Matlock et al found that prior to age 65, most TKA procedures were paid by private insurance carriers, while more than 80% of procedures for patients older than 65 were paid for by Medicare. [33] This is consistent with our finding of a significantly lower percentage of private payer status in the NIS than in the KID datasets (p < .0001). There is also a noticeable increase in procedure utilization at age 65, most likely a result of Medicare benefits going into effect for all patients over 65, including those who were previously uninsured.…”

“…There is also a noticeable increase in procedure utilization at age 65, most likely a result of Medicare benefits going into effect for all patients over 65, including those who were previously uninsured. [33,34] The analysis of the NIS database showed a correlation between private primary payer status and both length of stay and total charge (p < .0001). This relation was not seen in the KID analysis, where total charge only was correlated with length of stay in adolescents.…”

In-Hospital Patient Falls After Total Joint Arthroplasty

“…The economic data in our study are based on charge data, which may not entirely reflect the actual costs associated with hospitalization. Some authors believe that the use of administrative claims data in orthopedic surgery outcomes research is not entirely concordant to clinical records [35, 36], but the use of administrative data allows a broad perspective on the incidence, risk factors, and implications of IF and has been used extensively by us evaluating the early outcome of TJA surgery [26, 33, 34, 37–39]. Despite these limitations, the data sample used was nationally representative of the United States and was able to provide clinically useful data for a potentially preventable complication after TJA.…”

Few Insurance-Based Differences in Upper Extremity Elective Surgery Rates After Healthcare Reform

“…This work was performed at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. treatment, and outcomes in orthopaedics [2,4,11,22,26], portions of the new law are of particular interest, including the requirement to maintain minimal essential insurance coverage, the creation of government-run health insurance exchanges, and the creation of new partially subsidized healthcare plans [1,21]. With millions of Americans likely to become insured, there likely will be increased demand for orthopaedic care, and it is unclear how this new demand, and incentives from novel healthcare plans, will affect practice.…”