Does Medical Insurance Status Affect Outcomes?

This, perhaps, provocative question is particularly important given the patchwork healthcare insurance system in the United States. Could, for example, insurance status, health literacy or point of entry improve or hurt patient outcomes?

A new study from New York’s Hospital for Special Surgery (HSS) attempts to answer these important questions.

The study, “Do Patient Point of Entry and Medicaid Status Affect Quality Outcomes Following Total Knee Arthroplasty?,” appears in the July 1, 2020 edition of The Journal of Arthroplasty.

Co-author Jonathan M. Vigdorchik, M.D., a hip and knee surgeon at HSS, explained the vital importance of the study to OTW, “In light of current economic and social climates, research into healthcare disparities is of utmost importance. When seeing patients who are candidates for surgery, there is a certain stigma associated with different insurance types, whether commercial insurance, Medicare or healthcare exchange/Medicaid type programs.”

“In addition to insurance type, patients have a varying amount of health literacy, support systems, and resources available to them for their care. Our goal with this research was to evaluate whether patients using the same hospital protocols but different insurance types and different points of entry into the health care system (a private off[ice] versus a Medicaid-clinic) would have the same outcomes.”

The researchers retrospectively reviewed electronic medical records for all primary, unilateral total knee arthroplasties (TKAs) during January 2016 and January 2018. Those who had outpatient visits within the 6-month preoperative period were categorized as either Hospital Ambulatory Clinic Centers patients with Medicaid insurance or private office patients with non-Medicaid insurers. The researchers evaluated 174 Medicaid patients and 317 non-Medicaid patients, with the Medicaid patients being significantly younger.

The authors wrote, “After controlling for patient factors, the Medicaid effect was insignificant for surgical time and facility discharge. Medicaid status had a significant effect on length of stay (LOS)…”

“We showed that with well-established protocols, regardless of insurance type or patient entry, the outcomes in these patients were the all same,” said Dr. Vigdorchik to OTW. “It is extremely important to note that some of the Medicaid patients did require a higher utilization of healthcare services and resources, and increased coordination of their care, which does cost more to the health system as these patients stayed in the hospital longer.”

Citing the need for truly holistic care, Dr. Vigdorchik added, “Physicians and surgeons should treat all patients equally, regardless of where they come from, their race, gender, religion, etc…. Some patients may require more preoperative education, more preoperative services and coordination, and more help with their care when undergoing an operation. Hospitals and clinics should be appropriately staffed with social workers, care managers, and physician extenders to appropriate care for these more complex patients, because with appropriate care by caring, patients can all have excellent outcomes, which may save money to the health care system over the long-term.”