Abstract

Disparities in access to care based on insurance type exist for total hip arthroplasty (THA), but it is unclear if these lead to longer times to surgery. We evaluated whether rates of THA versus non-operative interventions (NOI) and time to THA from initial hip osteoarthritis (OA) diagnosis vary by insurance type.Using a national claims database, patients who had hip OA undergoing THA or NOI from 2011 to 2019 were identified and divided by insurance type: Medicaid managed care; Medicare Advantage; and commercial insurance. The primary outcome was THA incidence within 3 years after hip OA diagnosis. Multivariable logistic regression models were created to assess the association between THA and insurance type, adjusting for age, sex, region, and comorbidities.Medicaid patients had lower rates of THA within 3 years of initial diagnosis (7.4 vs. 10.9 or 12.0%, respectively; P<0.0001) and had longer times to surgery (297 vs. 215 or 261 days, respectively; P<0.0001) compared to Medicare Advantage and commercially insured patients. In multivariable analyses, Medicaid patients were also less likely to receive THA (Odds Ratio (OR) = 0.62 [95% Confidence Intervals (CI): 0.60-0.64] vs. Medicare Advantage, OR = 0.63 [95% CI: 0.61-0.64] vs. commercial) or NOI (OR = 0.92 [95% CI: 0.91-0.94] vs. Medicare Advantage, OR = 0.81 [95% CI: 0.79-0.82] vs. commercial).Medicaid patients experienced lower rates of and longer times to THA than Medicare Advantage or commercially insured patients. Further investigation into the causes of these disparities, such as patient costs or access barriers, is necessary to ensure equitable care.

View details for DOI 10.1016/j.arth.2023.09.029

View details for PubMedID 37778640