title: Health care subsidy and outcomes of total knee arthroplasty in Asians.
abstract: Singapore has a nonmodified universal health care system in which the government ensures affordable health care in the public health system, largely through a system of compulsory savings, subsidies, and price controls. Patients seeking treatment via the public health system may also choose for nonsubsidized options, with the benefits of being able to choose a surgeon, better privacy, and shorter time to surgery. To the authors' knowledge, few studies have reported the effect of health care subsidies on total knee arthroplasty outcomes. The purpose of this study was to assess whether patients receiving a health care subsidy had good outcomes or fared worse than their paying counterparts after undergoing conventional total knee arthroplasty. The authors retrospectively reviewed 369 patients who underwent total knee arthroplasty between 2006 and 2010. Patients were stratified into 2 groups: nonsubsidized (n=95) and subsidized patients (n=274). Outcome measures, such as range of motion, function score, knee score, Oxford Knee Questionnaire, and the Short Form 36 questionnaire, were compared between the groups at 6-month and 2-year follow-up. Subsidized patients had good postoperative outcomes, and no significance differences existed in outcome scores and range of motion between the 2 groups at 6-month and 2-year follow-up except in the mean function score, where patients in the nonsubsidized group did better (P=.019). Subsidized patients had good outcomes and did not fare worse than nonsubsidized patients after conventional total knee arthroplasty, except for their knee function score.
authors.affiliation: Department of Orthopaedic Surgery, Department of Physiotherapy, Singapore General Hospital, Singapore. hamidrazak@gmail.com
authors.forename: Hamid Rahmatullah
authors.initials: HR
authors.lastname: Bin Abd Razak
authors.forename: Toh Rui
authors.initials: TR
authors.lastname: Xiang
authors.forename: Chong Hwei
authors.initials: CH
authors.lastname: Chi
authors.forename: Tan Hwee Chye
authors.initials: TH
authors.lastname: Andrew
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000191:economics / Q000706:statistics & numerical data*; D044466:Asian People; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D012846:Singapore; D019472:Universal Health Insurance