Access to care for children with fractures

Area of Science:

• Pediatric Orthopaedics
• Healthcare Access
• Health Services Research

Background:

• Previous research indicated children with PPO insurance had no access issues for orthopaedic care, unlike those with Medicaid.
• This study investigates access to pediatric orthopaedic care based on insurance status.

Purpose of the Study:

• To evaluate access to orthopaedic care for children with fractures, comparing those with Medicaid versus PPO insurance.
• To determine the rate at which orthopaedic offices accept new pediatric patients with fractures and different insurance types.

Main Methods:

• A simulated patient (10-year-old boy with a forearm fracture) was used to request appointments from 100 randomly selected orthopaedic offices, with insurance status varied between Medicaid and PPO.
• Prospective data were collected on all pediatric fracture patients seen in the emergency department, including insurance status.

Main Results:

• Only 8% of offices offered an appointment within one week to a child with Medicaid insurance, compared to 36% for a child with PPO insurance.
• A significant majority (64%) of orthopaedic offices would not schedule an appointment for a child with a fracture, irrespective of insurance.
• Analysis of 2210 pediatric fractures showed similar payer mix for patients initially seen at the children's hospital versus those referred from outside facilities.

Conclusions:

• Most orthopaedic offices in the region would not treat a child with a fracture, indicating a widespread access problem.
• Children with Medicaid insurance face greater barriers in accessing timely orthopaedic care.
• Referral patterns to the children's hospital suggest care is sought for specialized needs rather than solely economic reasons.