Medicaid Patients Travel Disproportionately Farther for Revision Total Joint Arthroplasty

• Published in: The Journal of arthroplasty Vol. 39; no. 1; pp. 32 - 37
• Main Authors: Deans, Christopher F., Hulsman, Luci A., Ziemba-Davis, Mary, Meneghini, R. Michael, Buller, Leonard T.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2024
• Subjects: access to care; Aged; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; health policy; Humans; Medicaid; Medicare; Retrospective Studies; revision hip arthroplasty; revision knee arthroplasty; revision total joint arthroplasty; United States; United States; revision total joint arthroplasty; health policy; revision knee arthroplasty; access to care; revision hip arthroplasty
• ISSN: 0883-5403; 1532-8406; 1532-8406
• DOI: 10.1016/j.arth.2023.08.001

Access to high-quality care for revision total joint arthroplasty (rTJA) is poorly understood but may vary based on insurance type. This study investigated distance traveled for hip and knee rTJA based on insurance type. A total of 317 revision hips and 431 revision knees performed between 2010 and 2020 were retrospectively reviewed. Cluster sampling was used to select primary hips and knees for comparison. Median driving distance was compared based upon procedure and insurance type. Revision hip and knee patients traveled 18.2 and 11.0 miles farther for surgery compared to primary hip and knee patients (P ≤ .001). For hip rTJA, Medicaid patients traveled farther than Medicare patients followed by commercially insured patients with median distances traveled of 98.4, 67.2, and 35.6 miles, respectively (P = .016). Primary hip patients traveled the same distance regardless of insurance type (P = .397). For knee rTJA, Medicaid patients traveled twice as far as Medicare and commercially insured patients (medians of 85.0, 43.5, and 42.2 miles respectively, P ≤ .046). Primary knee patients showed a similar pattern (P = .264). Age and ASA-PS classification did not indicate greater comorbidity in Medicaid patients. Insurance type may influence rTJA referrals, with disproportionate referral of Medicaid and Medicare patients to nonlocal care centers. In addition to patient burden, these patterns potentially present a financial burden to facilities accepting referrals. Strategies to improve equitable access to rTJA, while maintaining the highest and most economical standards of care for patients, providers, and hospitals, are encouraged.