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Impact of Insurance Type on Access to Pediatric Surgical Care
Rachel R Watson1, Cassi J Niedziela1, Laura C Nuzzi1
1From the Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
Insights
Patients with public insurance experienced significantly more missed care opportunities (MCOs) in pediatric surgery compared to those with private insurance. However, access to surgical treatment and appointment cancellations did not differ between insurance groups.
Area of Science:
- Health Services Research
- Pediatric Surgery
- Health Equity
Background:
- Insurance type significantly impacts healthcare access and outcomes.
- Understanding disparities in pediatric surgical care is crucial for improving patient outcomes.
- Previous studies suggest potential inequities in care based on insurance status.
Purpose of the Study:
- To evaluate the influence of insurance type on pediatric surgical care access.
- To analyze differences in scheduling, cancellations, and missed care opportunities (MCOs) between public and private insurance groups.
- To identify potential barriers to equitable surgical care for children.
Main Methods:
- Retrospective review of 457 patients undergoing surgery in 2019.
- Analysis of demographics, clinical characteristics, and insurance type.
- Propensity score matching and linear regression to assess insurance impact on access and MCOs.
Main Results:
- No significant differences in consultation delays or clinic cancellations between insurance groups.
- Patients with public insurance had a 7.4 times higher rate of hospital MCOs (P < 0.001).
- Public insurance patients experienced 4.7 times more clinic MCOs (P = 0.007).
Conclusions:
- While timely access and cancellation rates were similar, public insurance is linked to higher MCOs in pediatric surgery.
- Disparities in missed care opportunities highlight the need for targeted interventions.
- Further research is needed to address barriers affecting marginalized patients' access to surgical care.
Background:
This study aimed to measure the impact of insurance type on access to pediatric surgical care, clinical and surgical scheduling decisions, provider-driven cancelations, and missed care opportunities (MCOs). We hypothesize that patients with public health insurance experience longer scheduling delays and more frequently canceled surgical appointments compared with patients with private health insurance.
Methods:
This retrospective study reviewed the demographics and clinical characteristics of patients who underwent a surgical procedure within the plastic and oral surgery department at our institution in 2019. Propensity score matching and linear regressions were used to estimate the effect of insurance type on hospital scheduling and patient access outcomes while controlling for procedure type and sex.
Results:
A total of 457 patients were included in the demographic and clinical characteristics analyses; 354 were included in propensity score matching analyses. No significant differences in the number of days between scheduling and occurrence of initial consultation or number of clinic cancelations were observed between insurance groups (P > 0.05). However, patients with public insurance had a 7.4 times higher hospital MCO rate (95% CI [5.2-9.7]; P < 0.001) and 4.7 times the number of clinic MCOs (P = 0.007).
Conclusions:
No significant differences were found between insurance groups in timely access to surgical treatment or cancelations. Patients with public insurance had more MCOs than patients with private insurance. Future research should investigate how to remove barriers that impact access to care for marginalized patients.
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