title: Insurance status does not predict curve magnitude in adolescent idiopathic scoliosis at first presentation to an orthopaedic surgeon.
abstract: BACKGROUND
  Previous studies have identified that children with public insurance have limited access to orthopaedic care. The purpose of this study was to explore the relationship between insurance status and curve magnitude at the time of presentation to an orthopaedic surgeon and time to treatment at a tertiary pediatric medical center.
  
  
  METHODS
  This study was retrospective review of all patients with idiopathic scoliosis over 10 years, who have not had previous spine surgery. Data were collected on demographics, insurance type, curve magnitude at presentation, source of referral, treatment initiated, and time from recommendation for surgery to surgical intervention.
  
  
  RESULTS
  Of the 642 patients included in this study, 53% were publicly insured and 45% were privately insured. Privately insured patients were significantly more likely to be seen as a second opinion (30% vs. 10%, P<0.001), and were significantly more likely to have received previous treatment (8% vs. 4%, P=0.011). Publicly insured patients were significantly more likely to be referred by their primary care doctor (64% vs. 50%, P=0.001) or as a part of school screening program (20% vs. 13%, P=0.036). At the time of presentation, there was no significant difference detected in major Cobb angles in the privately insured group [(private=28.7 (±15.4) degrees vs. public=26.4 (±16.8) degrees, P=0.076)]. There was no significant difference between the 2 groups in the number of patients who were recommended for operative treatment (public=11% vs. private 16%, P=0.072). However, in a multivariate regression analysis, publicly insured patients waited an average of 2.6 months longer for surgery than privately insured patients (P=0.010).
  
  
  CONCLUSIONS
  Patients with private insurance presenting for evaluation of idiopathic adolescent scoliosis were significantly more likely to present as a second opinion than those with government insurance. In this group of 642 patients, no significant differences were found in major Cobb angle at presentation or eventual need for surgery.
  
  
  METHODS
  Level III.
authors: Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
authors: Rachel Y
authors: RY
authors: Goldstein
authors: Elizabeth R A
authors: ER
authors: Joiner
authors: David L
authors: DL
authors: Skaggs
mesh_terms: D000293:Adolescent; D002140:California; D002648:Child; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000145:classification / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D009985:Orthopedics / Q000191:economics; D010372:Pediatrics / Q000191:economics; D012017:Referral and Consultation / Q000191:economics; D012189:Retrospective Studies; D012600:Scoliosis / Q000191:economics / Q000601:surgery; D061665:Time-to-Treatment / Q000191:economics