Disparities in major joint replacement surgery among adults with Medicare supplement insurance.

The objective of this study was to determine if disparities in hip and knee replacement surgery exist among osteoarthritis patients with AARP-branded Medicare supplement plan (ie, Medigap) coverage provided by UnitedHealthcare. Patients were selected into the study if they had 1 or more medical claims with a diagnosis of osteoarthritis from July 1, 2006 to June 30, 2007. Logistic regression analyses tested for age-, sex-, race-, or income-related differences in the likelihood of receiving a hip or knee replacement surgery. The regression models controlled for socioeconomics, health status, type of supplement plan, and residential location. Of the 2.2 million Medigap insureds eligible for this study, 529,652 (24%) had osteoarthritis. Of these, 32,527 (6.1%) received a hip or knee replacement. Males were 6% (P <  0.001) more likely than females to have a replacement surgery. Patients living in minority or lower income neighborhoods were less likely to receive a hip or knee replacement. Supplement plan type was not a strong predictor of the likelihood of hip or knee replacement. Disparities were much greater by comorbid condition and residential location. Disparities in hip and knee replacement surgery existed by age, sex, race, and income levels. Larger disparities were found by residential location and comorbid condition. Interventions are being considered to address these disparities.

[1]  J. Prescott,et al.  Descriptive Analysis of the Direct Medical Costs of Multiple Sclerosis in 2004 Using Administrative Claims in a Large Nationwide Database , 2007, Journal of managed care pharmacy : JMCP.

[2]  J. Katz,et al.  Epidemiology of total knee replacement in the United States Medicare population. , 2005, The Journal of bone and joint surgery. American volume.

[3]  Wilson Mg,et al.  Racial differences in the use of total knee arthroplasty for osteoarthritis among older Americans. , 1994 .

[4]  Steven Kurtz,et al.  Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. , 2005, The Journal of bone and joint surgery. American volume.

[5]  Daniel L Riddle,et al.  Yearly incidence of unicompartmental knee arthroplasty in the United States. , 2008, The Journal of arthroplasty.

[6]  H. Raspe,et al.  Knee replacement surgery for osteoarthritis: effectiveness, practice variations, indications and possible determinants of utilization. , 1999, Rheumatology.

[7]  E. Fisher,et al.  Racial Trends in the Use of Major Procedures among the Elderly , 2005 .

[8]  J. Skinner,et al.  Racial, ethnic, and geographic disparities in rates of knee arthroplasty among Medicare patients. , 2003, The New England journal of medicine.

[9]  Dove Hg,et al.  Episode Treatment Groups (ETGs): a patient classification system for measuring outcomes performance by episode of illness. , 2000 .

[10]  K. Hegmann,et al.  Relationships between body mass indices and surgical replacements of knee and hip joints. , 2003, American journal of preventive medicine.

[11]  J. Katz,et al.  Disparity in Total Hip Replacement Affecting Hispanic Medicare Beneficiaries , 2002, Medical care.

[12]  D. Matlock,et al.  Utilization of Elective Hip and Knee Arthroplasty by Age and Payer , 2008, Clinical orthopaedics and related research.

[13]  S. Schneeweiss,et al.  Joint replacement surgeries among medicare beneficiaries in rural compared with urban areas. , 2009, Arthritis and rheumatism.

[14]  M. Liang,et al.  Total hip arthroplasty: use and select complications in the US Medicare population. , 1996, American journal of public health.

[15]  D. May,et al.  Racial differences in the use of total knee arthroplasty for osteoarthritis among older Americans. , 1994, Ethnicity & disease.

[16]  Nancy A. Garrett,et al.  The boomers are coming: a total cost of care model of the impact of population aging on the cost of chronic conditions in the United States. , 2007, Disease management : DM.

[17]  J. Wright,et al.  Demographic variation in the rate of knee replacement: a multi-year analysis. , 1996, Health services research.

[18]  Elena Losina,et al.  Rates and Outcomes of Primary and Revision Total Hip Replacement in the United States Medicare Population , 2003, The Journal of bone and joint surgery. American volume.

[19]  D. Dunlop,et al.  Age and Racial/Ethnic Disparities in Arthritis-Related Hip and Knee Surgeries , 2008, Medical care.

[20]  K. Fiscella,et al.  Use of geocoding and surname analysis to estimate race and ethnicity. , 2006, Health services research.

[21]  A. McBean,et al.  Differences by Race in the Rates of Procedures Performed in Hospitals for Medicare Beneficiaries , 1994, Health care financing review.

[22]  S. Ettner,et al.  Adverse selection and the purchase of Medigap insurance by the elderly. , 1997, Journal of health economics.

[23]  J. Escarce,et al.  Use of geocoding in managed care settings to identify quality disparities. , 2005, Health affairs.

[24]  D. Dunlop,et al.  Racial Disparities in Joint Replacement Use Among Older Adults , 2003, Medical care.

[25]  D. Felson,et al.  Exploring the Determinants of Racial and Ethnic Disparities in Total Knee Arthroplasty: Health Insurance, Income, and Assets , 2008, Medical care.

[26]  John R. Wolfe,et al.  Adverse selection, moral hazard, and wealth effects in the Medigap insurance market. , 1991, Journal of health economics.

[27]  Olivier Ethgen,et al.  Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. , 2004, The Journal of bone and joint surgery. American volume.