title: Access to care for children with fractures.
abstract: BACKGROUND
  Earlier studies have found that children with fractures and PPO insurance have no access problems to orthopaedic care, but children with Medicaid have problems with access to orthopaedic care.
  
  
  METHODS
  Fifty randomly selected orthopaedic offices in each of the 2 counties served by a children's hospital were telephoned to seek an appointment for a fictitious 10-year-old boy with a forearm fracture. Each office was called twice, 1 time reporting that the child had PPO insurance and 1 time that he was having Medicaid. In the second arm of the study, data including insurance status were prospectively collected on all patients with fractures seen in the emergency department of children's hospital.
  
  
  RESULTS
  Of the 100 offices telephoned, 8 offices gave an appointment within 1 week to the child with Medicaid insurance. Thirty-six of the 100 offices gave an appointment within 1 week to the child with PPO insurance. For the 2210 pediatric fractures seen in the emergency department, the payer mix for patients presenting initially to our facility (1326 patients) was 41% Medicaid, 9% selfpay, and 50% commercial. For the patients presenting to our emergency department after being seen at an outside facility first (884 patients), the payer mix was 47% Medicaid, 13% self-pay, and 40% commercial. The percentages between these two groups were similar but did have a statistically significant difference (P=0.021).
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first study that reports a majority (64/100) of orthopaedic offices in the region would not care for a child with a fracture regardless of insurance status. Consistent with earlier studies, children with Medicaid have less access to care. The similar insurance status of children sent to the emergency department from other facilities compared with those presenting directly suggests that children in this study are sent to a children's hospital for specialized care rather than for economic reasons.
  
  
  METHODS
  Level II.
authors.affiliation: Miami Children's Hospital, Miami, FL 33155, USA. christopher.iobst@mch.com
authors.forename: Christopher
authors.initials: C
authors.lastname: Iobst
authors.forename: Wesley
authors.initials: W
authors.lastname: King
authors.forename: Avi
authors.initials: A
authors.lastname: Baitner
authors.forename: Michael
authors.initials: M
authors.lastname: Tidwell
authors.forename: Stephen
authors.initials: S
authors.lastname: Swirsky
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
mesh_terms: D000293:Adolescent; D002648:Child; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D050723:Fractures, Bone / Q000191:economics / Q000628:therapy*; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data; D019637:Orthopedic Procedures / Q000191:economics* / Q000379:methods; D011243:Preferred Provider Organizations / Q000706:statistics & numerical data; D011446:Prospective Studies; D014481:United States