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Access to Care for Children With Fractures

Iobst, Christopher MD*; King, Wesley MD*; Baitner, Avi MD*; Tidwell, Michael MD*; Swirsky, Stephen DO*; Skaggs, David L. MD

Journal of Pediatric Orthopaedics: April-May 2010 - Volume 30 - Issue 3 - p 244-247
doi: 10.1097/BPO.0b013e3181d413c5

Background Earlier studies have found that children with fractures and PPO insurance have no access problems to orthopaedic care, but children with Medicaid have problems with access to orthopaedic care.

Methods Fifty randomly selected orthopaedic offices in each of the 2 counties served by a children's hospital were telephoned to seek an appointment for a fictitious 10-year-old boy with a forearm fracture. Each office was called twice, 1 time reporting that the child had PPO insurance and 1 time that he was having Medicaid. In the second arm of the study, data including insurance status were prospectively collected on all patients with fractures seen in the emergency department of children's hospital.

Results Of the 100 offices telephoned, 8 offices gave an appointment within 1 week to the child with Medicaid insurance. Thirty-six of the 100 offices gave an appointment within 1 week to the child with PPO insurance. For the 2210 pediatric fractures seen in the emergency department, the payer mix for patients presenting initially to our facility (1326 patients) was 41% Medicaid, 9% selfpay, and 50% commercial. For the patients presenting to our emergency department after being seen at an outside facility first (884 patients), the payer mix was 47% Medicaid, 13% self-pay, and 40% commercial. The percentages between these two groups were similar but did have a statistically significant difference (P=0.021).

Conclusions To the best of our knowledge, this is the first study that reports a majority (64/100) of orthopaedic offices in the region would not care for a child with a fracture regardless of insurance status. Consistent with earlier studies, children with Medicaid have less access to care. The similar insurance status of children sent to the emergency department from other facilities compared with those presenting directly suggests that children in this study are sent to a children's hospital for specialized care rather than for economic reasons.

Level of Evidence Level II.

*Miami Children's Hospital, Miami, FL

Children's Hospital of Los Angeles, Los Angeles, CA

There was no external source of funding for this study.

None of the authors received financial support for this study.

Reprints: Christopher Iobst, MD, Miami Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155. E-mail:

Copyright © 2010 Wolters Kluwer Health, Inc. All rights reserved.