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Relationship between Insurance Type and Delays in Tympanostomy Tube Placement

Marissa Schwartz1,2, Rhea Shah3, Martha Wetzel4

  • 1Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.

The Annals of Otology, Rhinology, and Laryngology
|July 8, 2020
PubMed

Insights

Changes in health insurance and having Medicaid increase the likelihood of rescheduling tympanostomy tube surgery. This can cause significant delays in pediatric care.

Area of Science:

  • Pediatric Otolaryngology
  • Health Services Research
  • Health Insurance

Background:

  • Tympanostomy tube placement is a common pediatric surgical procedure.
  • Insurance status can impact healthcare access and timely delivery of care.
  • Previous research has not fully elucidated the impact of insurance changes on surgical scheduling.

Purpose of the Study:

  • To investigate the association between insurance carrier type and changes in insurance status with the rates of cancellation and rescheduling of tympanostomy tube surgery in pediatric patients.
  • To identify specific insurance-related factors contributing to surgical delays.

Main Methods:

  • Retrospective cohort study of pediatric patients (≤18 years) undergoing tympanostomy tube placement.
  • Data collected from January 1, 2013, to December 31, 2018, at a single tertiary care academic pediatric otolaryngology practice.
  • Logistic regression analysis used to determine factors associated with surgery cancellation or postponement, focusing on insurance changes and payer type (Medicaid vs. private insurance).

Main Results:

  • A total of 5080 patients were analyzed; 3.96% experienced an insurance change between their clinic visit and surgery date.
  • Patients who switched insurance had a significantly longer time to surgery (33 vs. 20 days, P < .001) and were nearly twice as likely to reschedule (OR 1.95).
  • Patients with Medicaid as the primary payer had increased odds of rescheduling or postponing surgery (OR 1.39).

Conclusions:

  • Changes in insurance carrier and loss or change of insurance are significantly associated with delays in tympanostomy tube placement.
  • The findings suggest that insurance-related administrative processes and coverage gaps contribute to postponements in pediatric surgical care.
  • Standardizing insurance re-enrollment schedules or exploring a single-payer system could mitigate these delays and improve timely access to essential pediatric procedures.
Abstract

Keywords:
ear tubeinsurancesurgery delay

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