The Effect of Community Type on Access to Orthopedic Services for Medicaid-Insured Patients

Abstract

Medicaid-insured patients have less access to specialty care compared to those who are privately insured. Limited and delayed access to orthopaedic services can affect patient outcomes, especially for patients living in rural areas. The purpose of this study was to evaluate the effect of community setting in access to orthopaedic care for Medicaid-insured patients. The study population included board-certified orthopaedic specialists obtained from the American Academy of Orthopaedic Surgeons (AAOS) within five Florida counties, representing urban and rural communities. Investigators used the Secret Shopper methodology to schedule an appointment for a rotator cuff repair. Medicaid acceptance rate, wait time, and average distance to clinics accepting Medicaid were calculated and compared between urban and rural counties. Of the 108 clinics identified, 76.9% performed arthroscopic rotator cuff repair. The appointment rate across all counties was 100% (n=83) for privately insured patients and 9.6% (n=8) for Medicaid patients. There was no significant difference in access when comparing access to care with Medicaid in urban and rural counties (p=0.984). Medicaid patients had significantly shorter wait times in rural counties compared to urban counties (p=0.021). Rural counties encountered a significantly greater average travel distance to clinics accepting Medicaid compared to urban counties (p=0.042). Medicaid-insured patients have limited access to orthopaedic care, regardless of community setting. Medicaid-insured patients in rural counties were more likely to have shorter wait times to the appointment and travel longer distances to clinics.