Factors in Hand Surgery Access for Rheumatoid Arthritis Before vs After the Patient Protection and Affordable Care...

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Public Health Policy

Background:

• Rheumatoid arthritis (RA) significantly impacts patient function and incurs substantial economic costs.
• The Patient Protection and Affordable Care Act (ACA) aimed to expand health insurance coverage, but its effects on access to specialized surgical care, like hand surgery for RA, remain unclear.
• Understanding these implications is crucial for addressing healthcare disparities.

Purpose of the Study:

• To investigate the impact of the ACA on the time to RA hand surgery, surgical incidence, and associated treatment costs.
• To identify demographic and socioeconomic factors influencing access to RA hand surgery post-ACA implementation.

Main Methods:

• A cross-sectional study analyzed insurance data from 2009-2020 (IBM MarketScan Research Databases).
• Patients aged 18+ with a new RA hand diagnosis undergoing specific hand surgeries were included.
• Comparisons were made between pre-ACA (before 2014) and post-ACA (2014 onwards) periods, analyzing time to surgery, incidence, and costs, while controlling for demographic and socioeconomic variables.

Main Results:

• Post-ACA, urban residents had significantly shorter times to surgery compared to nonurban residents.
• Increased social deprivation (higher Social Deprivation Index scores) was associated with longer delays in receiving RA hand surgery.
• Overall surgical incidence for RA hand surgery decreased significantly post-ACA, with a more pronounced reduction in nonurban populations.

Conclusions:

• The ACA's implementation has been associated with persistent disparities in accessing timely and cost-effective RA hand surgery.
• There is a critical need to enhance access to surgical hand specialists for nonurban populations and individuals facing greater social deprivation.
• Further insurance policy reforms are necessary to reduce out-of-pocket expenses for RA hand surgery and improve equitable access to care.