Effect of insurance type on fracture care delay

Delays in evaluating wrist and hand fractures can lead to corrective rather than primary treatment. We conducted a study to determine if insurance status affects management of wrist and hand fractures. We hypothesized that patients who had to fulfill authorization requirements (AR) to see an orthopedist would have longer delays in orthopedic evaluation and higher rates of corrective osteotomy when compared with patients who had direct access (DA). We retrospectively reviewed the charts of patients seen at an orthopedic clinic over a 4-year period. Evaluation delay and rate of corrective osteotomy were assessed. Of 916 patients, 549 had AR and 367 had DA. There was a significant (P<.001) delay in orthopedic evaluation of AR patients (mean, 21 days; SD, 20 days) vs DA patients (mean, 16 days; SD, 16 days). The age-adjusted odds ratio of corrective osteotomy in the AR group was statistically significant (P = .03) at 2.05 (95% confidence internal, 1.07-3.91). Requiring authorization to see an orthopedist introduces delay and a higher rate of corrective osteotomy among AR patients.