title: Disparity in preoperative patient factors between insurance types in total joint arthroplasty.
abstract: Equity in health care has become a focal point of debate. However, the disparity between insurance payer types in total joint arthroplasty is poorly defined. The authors identified 1312 consecutive patients who underwent elective primary total hip or knee arthroplasty with available preoperative Short Form 36 and Western Ontario and McMaster University Osteoarthritis Index surveys and stratified them into groups based on insurance type (Iowa Care [a state-run insurance program for patients who are indigent], Medicare, Medicaid, or private insurance) to compare demographics, access to care, and functional data. Significance was a P value less than .05 after a Turkey-Kramer adjustment for multiple comparisons. A multivariate analysis identified independent predictors of Short Form 36 and Western Ontario and McMaster University Osteoarthritis Index preoperative functional status. Few differences existed between patients with Iowa Care and Medicaid, but both groups had significantly lower Short Form 36 and Western Ontario and McMaster University Osteoarthritis Index scores across every category compared with patients with Medicare or private insurance (P<.05 for each comparison). In addition, patients with Iowa Care and Medicaid had a higher incidence of current smoking and higher mean body mass index and traveled an average of 29 to 30 miles farther for access to care (P<.05 for each comparison). Payer type was an independent predictor of preoperative Short Form 36 and Western Ontario and McMaster University Osteoarthritis Index functional scores in the multivariate analysis (P<.02). Significant differences exist between payer types in total joint arthroplasty. Further research is necessary to better inform health policy decisions.
authors.affiliation: Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, 01029 JPP, Iowa City, IA 52242, USA.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Martin
authors.forename: John J
authors.initials: JJ
authors.lastname: Callaghan
authors.forename: Steve S
authors.initials: SS
authors.lastname: Liu
authors.forename: Yubo
authors.initials: Y
authors.lastname: Gao
authors.forename: Richard C
authors.initials: RC
authors.lastname: Johnston
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D015992:Body Mass Index; D015897:Comorbidity; D017558:Elective Surgical Procedures; D005260:Female; D006305:Health Status Indicators; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D007348:Insurance, Health; D007484:Iowa; D008297:Male; D008484:Medicaid; D008483:Medical Assistance; D006278:Medicare; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000453:epidemiology / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000453:epidemiology / Q000601:surgery; D012907:Smoking / Q000453:epidemiology; D014481:United States