Fewer Hospitals Provide Operative Fracture Care to Medicaid Patients Than Otherwise-Insured Patients in 4 Large States.

OBJECTIVE: To determine whether Medicaid patients receive operative fracture care at an equal number of hospitals as otherwise-insured patients and to compare travel distances between Medicaid and otherwise-insured patients.

DESIGN: Retrospective, population-based cohort study of administrative health data.

SETTING: One thousand seventy-five hospitals in California, Florida, New York, and Texas.

PARTICIPANTS: Two hundred forty thousand three hundred seventy-six patients who underwent open reduction and internal fixation of a fracture of the radius/ulna, tibia/fibula, or humerus between 2006 and 2010 in Texas or New York, or between 2010 and 2014 in California or Florida.

INTERVENTION: Open reduction and internal fixation of the radius/ulna, tibia/fibula, or humerus.

MAIN OUTCOME MEASUREMENTS: The number of unique hospitals visited and the distance traveled for care were compared by payer status and admission acuity. The distance traveled was also stratified by urban versus rural geographic area.

RESULTS: In nonemergent settings, 7%-16% fewer hospitals saw Medicaid patients than otherwise-insured patients. In emergent settings, the gap between the number of hospitals seeing Medicaid and otherwise-insured patients was less than 5% in every state except Texas, where the gap was 11%-14%. The Medicaid and Medicare groups had longer travel distances in the nonemergent setting than in the emergent setting. Medicaid patients did not travel longer distances than otherwise-insured patients except in Texas, where they traveled 3-5 miles further than otherwise-insured patients in the nonemergent, urban setting.

CONCLUSIONS: Fewer hospitals provide operative fracture care to Medicaid patients than otherwise-insured patients, but Medicaid patients do not travel longer distances to the hospital on a population level.

LEVEL OF EVIDENCE: Prognostic Level III.