Investigating the Impact of Health Insurance on the Treatment of Distal Radius Fractures in New York State

Abstract

Background:

Prior studies have demonstrated that socioeconomic factors can influence decisions regarding care. The purpose of this study is to evaluate the impact of insurance type on the treatment of distal radius fractures.

Methods:

This was a retrospective study of patients in the New York Statewide Planning and Research Cooperative System database undergoing treatment for distal radius fractures. We stratified patients by insurance type, including private, Medicare, Medicaid, Workers’ Compensation, self-pay, or other coverage (disability insurance, government programs, no charge, no payment). Demographic information and comorbidities were identified, and multivariable regression analysis was used to control for potential confounders to determine factors associated with the likelihood of undergoing surgery.

Results:

A total of 37 053 patients with distal radius fractures were identified. And 5919 underwent operative intervention. The most common type of coverage was private insurance (40.9%), followed by Medicare (37.6%) and Medicaid (10.1%). Multivariable regression demonstrated a significantly lower rate of surgery in patients with Medicare (odds ratio [OR]: 0.80; 95% confidence interval [CI], 0.74-0.87; P < .001) and self-pay (OR: 0.45; 95% CI, 0.38-0.52; P < .001). There was a higher rate of surgery in patients with Workers’ Compensation (OR: 1.21; 95% CI, 1.07-1.37; P = .002).

Conclusions:

We show that rates of surgery for distal radius fractures vary by insurance type. Patients with Workers’ Compensation were more likely to undergo operative intervention for their injuries, while those with Medicare and self-pay were less likely to do so. In addition, there was no difference in surgical use among patients with commercial insurance or Medicaid.