The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

Insurance Type Affects Access to Care for Young Football Athletes with Hip Labrum Tears

Authors: Nathaniel Buchanan, BS, Jackson Byrd, BS, Clay A. Rahaman, BA, Mathew Hargreaves, MD, Maxwell L. Harrell, BS, Dev Dayal, BS, Elizabeth Powell, BS, Gerald McGwin PhD, MS, Thomas B. Evely, DO, Eugene W. Brabston, MD, Amit M. Momaya, MD, Aaron J. Casp, MD

Abstract

Objectives: Patients with Medicaid compared with private insurance have increased difficulty gaining access to orthopedic care. How insurance status affects access to care for young athletes (football; from here, all "young athletes" are football players) with hip labrum tears has yet to be assessed. The purpose of this study was to determine whether there is a difference in insurance acceptance rates for Medicaid versus Blue Cross Blue Shield (BCBS) for young athletes with a hip labral tear.

Methods: Fifty orthopedic clinics across 10 states were contacted using a standardized script. Each clinic was called twice: once as a young athlete with BCBS and once with a young athlete with Medicaid, requesting an appointment for a hip labral tear. The primary outcome was appointment success. Secondary outcomes included barriers to scheduling and wait times. Statistical analysis was performed using chi-squared and Mann-Whitney U tests.

Results: All clinics accepted BCBS insurance, whereas only 16 (32%) accepted Medicaid (P < 0.0001). Young athletes with BCBS successfully scheduled an appointment 100% of the time compared with only 24% for young athletes with Medicaid (P < 0.0001). Of the 34 clinics that did not accept Medicaid, 22 (65%) cited not accepting the insurance, and 11 (32%) required a referral. Among clinics that accepted both insurance types, there was no significant difference in median wait time (13 vs 14 days, P = 0.44).

Conclusions: For young athletes with hip labrum tears, it is more difficult to schedule appointments with Medicaid insurance compared with BCBS insurance. The main barrier to care with Medicaid for young athletes is requiring a primary care physician referral.
Posted in: Rheumatology and Orthopedics30

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References

1. Harris JD. Hip labral repair: options and outcomes. Curr Rev Musculoskelet Med 2016;9:361-367.
2. Berthelot JM, Brulefert K, Arnolfo P, et al. Update on contribution of hip labral tears to hip pain: a narrative review. Joint Bone Spine 2023;90:105465.
3. Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med 2009;2:105-117.
4. Zhang AL, Feeley BT. Editorial commentary: the rise of hip arthroscopy: temporary trend or here to stay? Arthrosc J Arthrosc Relat Surg 2018;34:1831-1832.
5. Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop 2003;417:112-120.
6. Sheu H, Yang TY, Tang HC, et al. The clinical outcomes of arthroscopic hip labral repair: a comparison between athletes and non-athletes. J Hip Preserv Surg 2022;9:102-106.
7. Iobst C, King W, Baitner A, et al. Access to care for children with fractures. J Pediatr Orthop 2010;30:244-247.
8. Pierce TR, Mehlman CT, Tamai J, et al. Access to care for the adolescent anterior cruciate ligament patient with Medicaid versus private insurance. J Pediatr Orthop 2012;32:245-248.
9. Skaggs DL, Lehmann CL, Rice C, et al. Access to orthopaedic care for children with Medicaid versus private insurance: results of a national survey. J Pediatr Orthop 2006;26:400-404.
10. Donohue JM, Cole ES, James CV, et al. The US Medicaid program: coverage, financing, reforms, and implications for health equity. JAMA 2022;328:1085-1099.
11. Manchikanti LA. critical analysis of Obamacare: affordable care or insurance for many and coverage for few? Pain Physician 2017;3:111-138.
12. Boden AL, Geller JS, Granger CJ, et al. Achilles injury and access to care in South Florida. Foot Ankle Spec 2022;15:105-112.
13. Kirchner GE, Rivers NJ, Balogh EF, et al. Does Medicaid expansion improve access to care for the first-time shoulder dislocator? J Shoulder Elbow Surg 2019;28:2079-2083.
14. Marrero CE, Igbokwe LI, Leonardi C. Access to orthopedic care post Medicaid expansion through the Affordable Care Act. J Natl Med Assoc 2019;111:148-152.
15. Hsiang WR, Lukasiewicz A, Gentry M, et al. Medicaid patients have greater difficulty scheduling health care appointments compared with private insurance patients: a meta-analysis. Inq J Med Care Organ Provis Financ 2019;56:0046958019838118.
16. Kim CY, Wiznia DH, Hsiang WR, et al. The effect of insurance type on patient access to knee arthroplasty and revision under the Affordable Care Act. J Arthroplasty 2015;30:1498-1501.
17. Kaiser Family Foundation. Status of state Medicaid expansion decisions: interactive map. https://www.kff.org/medicaid/status-of-state-medicaid-expansion-decisions/. Published May 8, 2024. Accessed September 18, 2024.
18. Kim CY, Wiznia DH, Roth AS, et al. Survey of patient insurance status on access to specialty foot and ankle care under the Affordable Care Act. Foot Ankle Int 2016;37:776-781.
19. Cifuentes P, Jaramillo M, Garrote F, et al. Impact of insurance type on access to pain management specialists for the treatment of lower back pain. Cureus 2024;16:e51668.
20. Benitez J, Freed SS, Huang H, et al. Did Medicaid reimbursements shape the effects of Medicaid expansion on access to health care among the low-income population? J Gen Intern Med 2024;39:1360-1368.
21. Saulsberry L, Seo V, Fung V. The impact of changes in Medicaid provider fees on provider participation and enrollees’ care: a systematic literature review. J Gen Intern Med 2019;34:2200-2209.
22. Creedon TB, Zuvekas SH, Hill SC, et al. Effects of Medicaid expansion on insurance coverage and health services use among adults with disabilities newly eligible for Medicaid. Health Serv Res 2022;57( Suppl 2 ):183-194.
23. Lyon SM, Douglas IS, Cooke CR. Medicaid expansion under the Affordable Care Act. Implications for insurance-related disparities in pulmonary, critical care, and sleep. Ann Am Thorac Soc 2014;11:661-667.
24. Mellor JM, McInerney M, Garrow RC, et al. The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries. Health Serv Res 2023;58:1024-1034.
25. Zuvekas SH, McClellan CB, Ali MM, et al. Medicaid expansion and health insurance coverage and treatment utilization among individuals with a mental health condition. J Ment Health Policy Econ 2020;23:151-182.
26. Cianci A, Sugimoto D, Stracciolini A, et al. Nonoperative management of labral tears of the hip in adolescent athletes: description of sports participation, interventions, comorbidity, and outcomes. Clin J Sport Med 2019;29:24-28.