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Goal:
To determine whether Medicaid patients receive fracture surgical care in an equal number of hospitals compared to otherwise insured patients and to compare travel distances between Medicaid and otherwise insured patients.
Design:
Population-based retrospective cohort study of administrative health data.
Setting:
One thousand seventy-five hospitals in California, Florida, New York and Texas.
participants:
Two hundred and forty thousand three hundred and seventy-six patients undergoing open reduction and internal fixation of a fracture of the radius / ulna, tibia / fibula or humerus between 2006 and 2010 in Texas or New York York, or between 2010 and 2014 in California or Florida.
Intervention:
Open reduction and internal fixation of the radius / ulna, tibia / fibula or humerus.
Key outcome measures:
The number of unique hospitals visited and the distance traveled for care were compared by payor status and admission acuity. The distance traveled was also stratified by urban or rural geographical area.
Results:
In a non-medical setting, Medicaid patients treated with Medicaid were 7% to 16% less likely than otherwise insured patients. In emerging countries, the gap between the number of hospitals hosting Medicaid patients and those otherwise insured was less than 5% in all states, with the exception of Texas, where it was included between 11% and 14%. The Medicaid and Medicare groups traveled longer distances in non-submerged contexts than in emerging countries. Medicaid patients did not travel longer distances than otherwise insured patients, except in Texas, where they traveled 3 to 5 miles longer than otherwise insured patients in a non-submerged urban environment.
conclusions:
Fewer hospitals offer surgical fracture care to Medicaid patients than otherwise insured patients, but Medicaid patients do not travel long distances to the hospital at the population level.
Level of evidence:
Prognosis Level III.
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