Abstract
BACKGROUND: Public insurance has recently been associated with a decreased likelihood of receiving surgery to address glenohumeral instability in several state-specific analyses. The purpose of this study is to expand this literature and analyze this association in a nationwide sample. METHODS: A national insurance claims database was used to identify shoulder dislocations between 2011 through 2019. Patients were stratified by insurance status (Medicaid or commercial) and age (5-24, 25-44, and 45-64 years). Billing codes were used to identify surgical stabilization and recurrent dislocations. Multivariable logistic regression was performed to compare the likelihood of surgical stabilization and recurrent instability. RESULTS: Of 292 672 patients, those with Medicaid were 48% less likely to receive surgery within 30 days, 32% less likely within 1 year, and 31% less likely within 2 years of their dislocation. When compared to those with commercial insurance, patients aged 45-64 years with Medicaid were the least likely to undergo surgery to address their shoulder instability (OR = 0.51, 95% CI, 0.40-0.65, p < 0.001). CONCLUSION: Patients with Medicaid insurance are less likely to have their glenohumeral dislocation managed surgically, highlighting the limited healthcare access of patients with Medicaid insurance.