title: Anterior cruciate ligament injury and access to care in South Florida: does insurance status play a role?
abstract: BACKGROUND
  Health insurance status and access to care are recurring topics of discussion and concern. The purpose of this investigation was to examine access to care on the basis of insurance status for patients with anterior cruciate ligament (ACL) injuries in South Florida.
  
  
  METHODS
  From March 2010 to March 2011, eighty patients with ACL injuries were identified at a county hospital sports medicine clinic and a university-based sports medicine practice. Demographic and injury-specific data were obtained with attention to the date of injury, the date of diagnosis, and the number of medical visits. Hazard ratios and 95% confidence intervals were calculated from multivariable Cox proportional-hazards regression models to determine the effect of insurance type on the time to diagnosis of an ACL tear.
  
  
  RESULTS
  Patients with private insurance were diagnosed at a median fourteen days after the injury, whereas those receiving Medicaid and those without insurance were diagnosed a median of fifty-six and 121 days after the injury, respectively (p < 0.001). Patients without insurance and those receiving Medicaid had more medical visits prior to diagnosis (median, four; range two to six) than those with private insurance (median, three; range, one to five) (p = 0.006). Differences for patient delays due to not seeking care were not significant among the three groups (p = 0.484).
  
  
  CONCLUSIONS
  When grouped according to insurance status, subjects receiving Medicaid in South Florida faced greater system-related delays in obtaining care than did subjects with private insurance. System-related factors such as lack of access to specialized care result in an increased number of medical encounters. These regional findings are consistent with those of other regional studies on access to orthopaedic care.
authors: Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Miami, FL 33136, USA. mbaraga@med.miami.edu
authors: Michael G
authors: MG
authors: Baraga
authors: Marvin K
authors: MK
authors: Smith
authors: Jean P
authors: JP
authors: Tanner
authors: Lee D
authors: LD
authors: Kaplan
authors: Bryson P
authors: BP
authors: Lesniak
mesh_terms: D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries; D005260:Female; D005431:Florida / Q000453:epidemiology; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D007718:Knee Injuries / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models