Elective Hand Surgery Is Delayed among Private Insurance Holders

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Health Economics

Background:

• Patients with private health insurance often postpone elective procedures until year-end to meet insurance deductibles.
• No prior studies have investigated the impact of insurance status and hospital setting on the timing of upper extremity surgeries.

Purpose of the Study:

• To examine how insurance status and hospital setting influence the timing of elective upper extremity surgeries, specifically focusing on end-of-year case volumes.
• To analyze surgical timing for carpometacarpal (CMC) arthroplasty, carpal tunnel release, cubital tunnel release, trigger finger release, and distal radius fixation.

Main Methods:

• Retrospective review of electronic medical records from a university and a physician-owned hospital (2010-2019).
• Analysis included CMC arthroplasty, carpal tunnel release, cubital tunnel release, trigger finger release, and distal radius fixation.
• Surgical dates were categorized by fiscal quarter (Q1-Q4); case volumes in Q4 were compared to Q1-Q3 using the Poisson exact test for private and public insurance groups.

Main Results:

• Overall surgical case counts were higher in Q4 across both institutions.
• A greater proportion of privately insured patients underwent hand and upper extremity surgery at the physician-owned hospital (69.7%) compared to the university center (50.3%).
• Privately insured patients showed a significantly higher rate of CMC arthroplasty and carpal tunnel release in Q4 versus Q1-Q3, unlike publicly insured patients.

Conclusions:

• The timing of elective procedures, such as CMC arthroplasty and carpal tunnel release, is significantly influenced by private insurance status, likely due to deductible considerations.
• Further research is warranted to understand the financial and medical implications of delayed elective surgeries driven by insurance plan structures.