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J Arthroplasty. 2008 Sep;23(6 Suppl 1):9-14. doi: 10.1016/j.arth.2008.05.010.

Impact of payer type on resource utilization, outcomes and access to care in total hip arthroplasty.

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  • 1Department of Orthopaedic Surgery, University of California, San Francisco, California, USA.


The purpose of this study was to determine if Medicaid patients undergoing a primary total hip arthroplasty differed from Medicare and commercial-payer patients with respect to baseline demographic characteristics, social history, clinical outcomes, and resource utilization. A retrospective review of 224 subjects who received a primary total hip arthroplasty at a single institution was conducted and stratified by insurance type. Baseline clinical and demographic information and functional outcomes were compared between Medicaid, Medicare, and commercial-payer patients. Medicaid patients had lower preoperative (P < .0001) and postoperative (P < .0001) Harris Hip Scores when compared with patients who have Medicare or commercial insurance. Medicaid patients also traveled twice as far to receive treatment (66.0 vs 38.3 miles). Decreased access to health care and increased time to presentation may account for the decreased functional scores and poorer clinical outcomes observed in Medicaid patients when compared with Medicare and commercially insured patients.

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