Impact of Insurance Type on Access to Pediatric Surgical Care

Author:

Watson Rachel R.1,Niedziela Cassi J.1,Nuzzi Laura C.1,Netson Rebecca A.1,McNamara Catherine T.1,Ayannusi Anuoluwa E.1,Flanagan Sarah1,Massey Gabrielle G.1,Labow Brian I.1

Affiliation:

1. From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass.

Abstract

Background: This study aimed to measure the impact of insurance type on access to pediatric surgical care, clinical and surgical scheduling decisions, provider-driven cancelations, and missed care opportunities (MCOs). We hypothesize that patients with public health insurance experience longer scheduling delays and more frequently canceled surgical appointments compared with patients with private health insurance. Methods: This retrospective study reviewed the demographics and clinical characteristics of patients who underwent a surgical procedure within the plastic and oral surgery department at our institution in 2019. Propensity score matching and linear regressions were used to estimate the effect of insurance type on hospital scheduling and patient access outcomes while controlling for procedure type and sex. Results: A total of 457 patients were included in the demographic and clinical characteristics analyses; 354 were included in propensity score matching analyses. No significant differences in the number of days between scheduling and occurrence of initial consultation or number of clinic cancelations were observed between insurance groups (P > 0.05). However, patients with public insurance had a 7.4 times higher hospital MCO rate (95% CI [5.2–9.7]; P < 0.001) and 4.7 times the number of clinic MCOs (P = 0.007). Conclusions: No significant differences were found between insurance groups in timely access to surgical treatment or cancelations. Patients with public insurance had more MCOs than patients with private insurance. Future research should investigate how to remove barriers that impact access to care for marginalized patients.

Funder

CRICO/ Risk Management Foundation of the Harvard Medical Institutions

Publisher

Ovid Technologies (Wolters Kluwer Health)

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