Two State Comparison of Total Joint Arthroplasty Utilization Following Medicaid Expansion
Christopher J. Dy, MD, MPH,1,2,* Derek Brown, PhD,3 Hera Maryam, BS,1 Matthew Keller, MS,4 and Margaret A. Olsen, PhD, MPH2,4Hip Knee
BACKGROUND:
While Medicaid expansion has improved access to primary care services, its impact on surgical specialty utilization remains unclear. To determine whether Medicaid expansion was associated with increased compared utilization rates of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in Illinois (which expanded Medicaid) relative to Missouri (which did not expand Medicaid).
METHODS:
Using administrative data sources, we analyzed 374,877 total hospitalizations (236,333 in Illinois and 138,544 in Missouri) for THA/TKA from 2011–2016 (Illinois’ Medicaid expansion date: 1/1/2014).
RESULTS:
The percentage of THA/TKA funded by Medicaid in Illinois was 2.4% in 2013 and 3.9% in 2016 (Missouri – 2013: 2.7%; 2016: 2.6%). A difference-in-difference analysis (adjusted for patient age and sex, county-level Area Deprivation Index, and number of orthopaedic surgeons) demonstrated a statistically significant increase in Medicaid-funded THA/TKA in Illinois in 2016 compared to 2013 (p=0.012).
CONCLUSIONS:
Our study demonstrates that Medicaid expansion in Illinois was associated with increased utilization of THA and TKA. Further study is needed to understand the impact of Medicaid expansion in other states and for other procedures.
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