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Does Insurance Status Affect Access to Care Among Ankle Fracture Patients? An Institutional Retrospective Study


McKissack HMHaley M , Viner GCGean C , McMurtrie JTJames T , Alexander BKBradley K , Jha AJAaradhana J , Wilson JTJohn T , Shah ABAshish B . The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. 2020 10 7; 60(3). 520-522


Delayed access to care for patients with ankle fractures may increase risk of complications, particularly if surgical management is warranted. Medicaid is a state and federal insurance program in place for those with low income, which has previously been associated with delayed access to care among patients with ACL tears and total hip arthroplasties. The purpose of this study is to assess whether patient insurance status affects access to care for ankle fracture patients, using data from a single institution. A retrospective cohort study (N = 311 patients)was performed on individuals that underwent open reduction and internal fixation for an ankle fracture between years 01/2008 and 12/2018. Patients with polytraumatic injuries, open injuries, Medicare, no insurance, indigent/charity insurance, self-pay, or whose insurance information was not available were excluded. Time from date of injury to date of surgery, injury to first visit, and first visit to surgery was compared between patients with private insurance and Medicaid. Average time from injury to first appointment was 1.2 days and 6.2 days for privately insured and Medicaid patients, respectively (p < .001). Average time from injury to surgery was 8.3 days and 16.1 days for privately insured and Medicaid patients, respectively (p < .001). Patients enrolled in Medicaid have significantly delayed access to care compared to those with private insurance. For ankle fracture patients this is a critical healing time, and delayed care may result in increased costs, increased utilization of healthcare resources, higher complication rates, and poorer patient outcomes.