2014 Papers - Kuba


Pediatric Access to Care: A look at Orthopaedic Access in the State of Hawaii

Megan Kuba Orthopaedic Residency Program, University of Hawaii


Introduction: Access to medical care for children requiring orthopaedic services has been shown to correlate with the type of insurance that the patient has, as well as the state's insurance reimbursement rate. Children with state-funded Medicaid insurance have less access to health care than do children with private insurance. Our study evaluated the availability of timely orthopaedic care to the pediatric patient with a broken arm who has private insurance versus Hawaii State Medicaid.

Methods: All orthopaedic surgeons, excluding those at Kaiser Permanente or Tripler Army Medical Center, currently practicing on the island of Oahu in the state of Hawaii were selected for participation. The main office number for each private practitioner or group was telephoned with the following scenario: "My 10-year-old son broke his wrist 2 days ago; the fracture does not involve the growth plate. He is now splinted and we were told to follow up with an orthopaedic surgeon." Each office was called twice, a minimum of two weeks apart with the same scripted story except for the insurance status. During one call the child was said to have a private PPO insurance, and during the other he had Medicaid.

Results: There are 28 private practices or group offices on the Island of Oahu. 50% of these providers gave an appointment to our hypothetical child within 1 week, regardless of insurance type. 68% of offices polled gave an appointment to the child with private insurance at an average of 1.3 days, as compared to 52% of offices offered an appointment to the child with Medicaid at an average of 2.5 days. The differences in percentage offering an appointment and time until the appointment was given were not statistically significant. 80% of those offices who would not give an appointment were able to recommend another provider who did.

Conclusions: Previously published studies in other states have reported extremely poor access to care for the child with Medicaid. Our study indicates that in the state of Hawaii, insurance is not a significant barrier to medical care for children with a common orthopaedic injury.