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Inequalities in Pediatric Fracture Care Timeline Based on Insurance Type
Brock T Kitchen1, Samuel S Ornell, Kush N Shah
1From the University of Texas Health Science Center at San Antonio, San Antonio, TX (Dr. Kitchen, Mr. Ornell, Dr. Shah, Dr. Pipkin, Ms. Tips, and Dr. Hogue), and the Harvard University, Boston, MA (Dr. Hogue).
Insights
Children with lower socioeconomic status face delays in orthopedic care due to reliance on government-funded insurance. This impacts timely fracture evaluation and treatment for pediatric patients.
Area of Science:
- Orthopaedic surgery
- Health services research
- Pediatric healthcare
Background:
- Access to healthcare is often limited by socioeconomic and insurance status.
- Despite initiatives, pediatric orthopaedic patients experience delays in fracture treatment.
- Timelines for these delays in pediatric orthopaedic care are not well-characterized.
Purpose of the Study:
- To evaluate the impact of ethnicity, socioeconomic status, and insurance type on pediatric orthopaedic care timelines.
- To identify delays in care for pediatric fracture patients within a specific community.
Main Methods:
- Retrospective chart review of pediatric patients with common fractures.
- Collection of patient demographics and care timelines.
- Inclusion of 413 pediatric patients.
Main Results:
- Patients with government-funded insurance (60.6%) experienced significant delays (P < 0.001) compared to commercially insured patients.
- Delays in injury-to-referral and injury-to-evaluation were 4.4 and 9.2 days, respectively (2.8 and twofold greater).
- A strong correlation exists between income levels and insurance type.
Conclusions:
- Lower socioeconomic status in pediatric patients is linked to reliance on government-funded insurance.
- This reliance is associated with significant delays in fracture evaluation and subsequent orthopaedic care.
Introduction:
Socioeconomic and insurance status are often linked with limited access to health care. Despite several government-funded projects aimed at curtailing these barriers, pediatric orthopaedic patients continue to experience delays in receiving timely care for fracture treatments. This delay has been well-identified within the orthopaedic literature but, to our knowledge, has never been characterized based on timeline. Thus, the goal of this study is to evaluate the role of ethnicity, socioeconomic status, and insurance type on the timeline of pediatric patients to obtain orthopaedic care within our community.
Methods:
Pediatric patients presenting to our clinic for the treatment of one of 21 most common fractures were included. Patient demographics and the timeline of patient care were collected by retrospective chart review.
Results:
Government-funded insurance accounted for 60.6% of the 413 patients. These patients experienced significant (P < 0.001) delays in access to care when compared with commercial insurance patients; the time between injury and referral as well as the overall time from injury to orthopaedic evaluation was 2.8 and twofold greater at 4.4 days and 9.2 days, respectively. A strong correlation was established between income levels and insurance type.
Discussion:
Pediatric patients with a lower socioeconomic status are more likely to rely on government-funded insurance and experience delays in fracture evaluation.
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