The Effect of Insurance Type on Patient Access to Carpal Tunnel Release Under the Affordable Care Act

Purpose: To assess the effect of insurance type (Medicaid, Medicare, and private insurance) on access to hand surgeons for carpal tunnel syndrome (CTS).

Methods: The research team called 240 hand surgeons in 8 states (California, Massachusetts, Ohio, New York, Florida, Georgia, Texas, and North Carolina). The caller requested an appointment for her fictitious mother to be evaluated for CTS and possible surgical management through carpal tunnel release (CTR). Each office was called 3 times to assess the responses for Medicaid, Medicare, or Blue Cross Blue Shield. From each call, we recorded whether an appointment was given and whether there were barriers to an appointment, such as the need for a referral.

Results: Twenty percent of offices scheduled an appointment for a patient with Medicaid, compared with 89% for Medicare and 97% for Blue Cross Blue Shield. Patients with Medicaid had an easier time scheduling appointments (28% vs 13%) and experienced fewer requests for referrals (25% vs 67%) in states with expanded Medicaid eligibility. Neither Medicaid nor Medicare reimbursement for CTR was significantly correlated with the incidence of successful appointments. Although the difference in Medicaid and Medicare reimbursements for CTR was small, the appointment success incidence for Medicare was approximately 5 times higher.

Conclusions: Despite the passage of the Affordable Care Act, patients with Medicaid have reduced access to surgical care for CTS and more complex barriers to receiving an appointment. Although Medicaid was accepted at a higher rate in states with expanded Medicaid eligibility, a more robust strategy for increasing access to care may be helpful for patients with Medicaid.

Type of study/level of evidence: Prognostic II.