Public Insurance Causes Delays for Treating Patellar Instability

Significant delays were reported in a new study for pediatric and adolescent patients with patellar instability and public insurance.

The study, “Association of Insurance Status With Treatment Delays for Pediatric and Adolescent Patients Undergoing Surgery for Patellar Instability,” published on May 12, 2022 in the Orthopaedic Journal of Sports Medicine.

“Health care disparities have been highlighted in pediatric sports medicine, but the association between insurance status and delayed care for patients undergoing surgery for patellar instability has not been defined,” the researchers wrote.

For the study, the researchers wanted to know if there is an association between insurance status and delays in care in pediatric and adolescent patients undergoing surgery for patellar instability.

All the retrospective cases took place at a safety-net tertiary referral center. Insurance status was classified as either public or private. The researchers calculated the times from injury to clinical evaluation, injury to magnetic resonance imaging, injury to surgery, clinical evaluation to MRI, and clinical evaluation to surgery.

Of the 78 patients included in the study, 38 had public insurance and 40 had a private form. The public insurance group was older (p = .019), with a lower proportion of white patients (5.8% vs 52.5%; p = .0005), higher proportion of Hispanic ethnicity (55.3% vs. 15.0%; p = .0001) and higher proportion of Spanish-speaking patients (21.1% vs. 2.5%, p = .007).

Publicly insured patients had longer times from initial injury to clinical evaluation (466 vs. 77 days; p = .002), MRI (466 vs. 82 days; p = .003), and surgery (695 vs. 153 days; p = .0003), as well as a longer time from clinical evaluation to surgery (226 vs. 73 days; p = .002).

The researchers found insurance status to be an independent predictor in each of the identified delays. The patients with public insurance took 6 times longer to get a clinical evaluation and more than 5.5 times longer to obtain an MRI compared with the patients with private insurance. It also took 4.5 times longer for them to get the surgery.

“Even after adjusting for delays to clinical evaluation, publicly insured patients had a delay from clinic to surgery that was triple that of privately insured patients,” the researchers wrote.

The study authors included Sachin Allahabadi, M.D., Ryan T. Halvorson, M.D., and Nirav K. Pandya, M.D., all from the University of California, San Francisco.