title: Access to outpatient care for adult rotator cuff patients with private insurance versus Medicaid in North Carolina.
abstract: BACKGROUND
  Access to orthopaedic care for pediatric patients has been shown in previous studies to be decreased for patients with Medicaid compared with those with private insurance. The relationship between type of insurance and access to care for adult patients with acute rotator cuff tears has not yet been examined. This study aimed to determine if type of health insurance would have an impact on access to care for an adult patient with an acute rotator cuff tear.
  
  
  METHODS
  Seventy-one orthopaedic surgery practices within the state of North Carolina were randomly selected and contacted on 2 different occasions separated by 3 weeks. The practices were presented with an appointment request for a fictitious 42-year-old man with an acute rotator cuff tear. Insurance status was reported as Medicaid for the first call and as private insurance during the second call.
  
  
  RESULTS
  Of the 71 practices contacted, 51 (72%) offered the patient with Medicaid an appointment, whereas 68 (96%) offered the patient with private insurance an appointment. The difference in these rates was statistically significant (P < .001). The likelihood of patients with private insurance obtaining an appointment was 8.8 times higher than that of patients with Medicaid (95% CI: 2.5, 31.5).
  
  
  CONCLUSIONS
  For patients with acute rotator cuff tears, access to care is decreased for those with Medicaid compared with those with private insurance. Patients with private insurance are 8.8 times more likely than those with Medicaid to obtain an appointment.
  
  
  METHODS
  Basic science, survey study.
authors.affiliation: University of North Carolina, Department of Orthopaedic Surgery, Chapel Hill, NC, USA.
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Patterson
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Spang
authors.forename: Reid W
authors.initials: RW
authors.lastname: Draeger
authors.forename: Erik C
authors.initials: EC
authors.lastname: Olsson
authors.forename: Robert A
authors.initials: RA
authors.lastname: Creighton
authors.forename: Ganesh V
authors.initials: GV
authors.lastname: Kamath
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics*; D001071:Appointments and Schedules; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health / Q000191:economics*; D008297:Male; D008484:Medicaid / Q000191:economics; D009657:North Carolina; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D013708:Tendon Injuries / Q000191:economics* / Q000601:surgery; D014481:United States
keywords: Affordable Care Act; Basic Science; Medicaid; Rotator cuff tear; Survey Study; health care access