title: Few insurance-based differences in upper extremity elective surgery rates after healthcare reform.
abstract: BACKGROUND
  Before the US Patient Protection and Affordable Care Act of 2010, there were documented insurance-based disparities in access to orthopaedic surgeons and care of orthopaedic conditions. While Massachusetts passed healthcare reform in 2007 with many similar provisions, it is unknown whether the disparities were present during the period of the law's enactment.
  
  
  OBJECTIVE
  We asked whether differences in rates of surgery between patients with novel government-subsidized healthcare plans and other forms of insurance, and between uninsured and insured patients, were similar after institution of the Massachusetts reform laws.
  
  
  METHODS
  We identified 7577 patients diagnosed with upper extremity injuries between January 1, 2007 and October 1, 2010. From an institutional administrative database, we extracted demographics, insurance status, and plan of care. Insurance categories included government-subsidized healthcare plan (Commonwealth Care), private insurance, workers compensation, military-related (TriCare), Medicare, Medicaid (MassHealth), non-Commonwealth Care, and other insured and uninsured. After adjusting for age, gender, and diagnosis, we compared the proportions of patients who underwent elective surgery.
  
  
  RESULTS
  Of 7577 patients, 1685 (22%) underwent elective upper extremity surgery. The adjusted rates of surgery were similar across most insurance categories, with higher rates in the workers compensation and TriCare categories compared with Commonwealth Care. Uninsured patients were as likely to undergo surgery as insured patients.
  
  
  CONCLUSIONS
  In a population with near-universal health insurance, a government-run health insurance exchange, and novel, government-subsidized, managed care plans, we found few insurance-based differences in rates of elective upper extremity orthopaedic surgery in a cohort of patients after healthcare reform.
authors.affiliation: Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA 02115, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: McGlaston
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Kim
authors.forename: Philip
authors.initials: P
authors.lastname: Schrodel
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Deangelis
authors.forename: Arun J
authors.initials: AJ
authors.lastname: Ramappa
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001900:Boston; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D006078:Government Programs / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D018166:Health Care Reform / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D019637:Orthopedic Procedures / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D017149:Private Sector / Q000706:statistics & numerical data; D014481:United States; D034941:Upper Extremity / Q000601:surgery*; D014942:Workers' Compensation / Q000706:statistics & numerical data