Access to Care for the Adolescent Anterior Cruciate Ligament Patient With Medicaid Versus Private Insurance

Purpose: To determine the potential impact of type of health insurance on access to outpatient orthopaedic care for an adolescent patient with an acute anterior cruciate ligament (ACL) tear. Methods: The offices of 42 orthopaedic surgeons in the Greater Cincinnati area, to include Ohio, Indiana, and Kentucky were contacted on 2 separate occasions describing a fictitious 14-year-old male with an acute ACL tear. The 2 calls were separated by a period of 2 to 4 weeks. The independent variable was the patient's insurance status, reported as either Medicaid or private insurance. Statistical comparison of the rates of successful appointment scheduling was performed through the Fisher exact test. Results: Thirty-eight of 42 Orthopaedic surgery practices (90%) offered the privately insured 14-year-old ACL patient an appointment within 2 weeks, while only 6 of 42 (14%) offered the Medicaid patient such an appointment. The difference in these rates was statistically significant (P < 0.0001) with the odds of getting an appointment with private insurance being 57 times higher than that with Medicaid (95% confidence interval: 12.87, 288.62). Conclusions: Access to orthopaedic care for children on Medicaid continues to be a problem in the United States. Previous pediatric studies have documented that the reason for these discrepancies in access are related primarily to Medicaid reimbursement rates (approximately 23% of private insurance). Ours is the first study to show that these same limitations exist for teenagers with acute knee injuries likely to require surgery.