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Previous Volume 331:444-449 August 18, 1994 Number 7 Next

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ABSTRACT

Background We studied differences in the incidence of appendiceal perforation in patients with acute appendicitis according to their insurance coverage.

Methods In a retrospective analysis of hospital-discharge data, we examined the likelihood of ruptured appendix among adults 18 to 64 years old who were hospitalized for acute appendicitis in California from 1984 to 1989.

Results After controlling for age, sex, psychiatric diagnoses, substance abuse, diabetes, poverty, race or ethnic group, and hospital characteristics, we found that ruptured appendix was more likely among both Medicaid-covered and uninsured patients with appendicitis than among patients with private capitated coverage (odds ratios, 1.49 [95 percent confidence interval, 1.41 to 1.59] and 1.46 [95 percent confidence interval, 1.39 to 1.54], respectively). After adjustment for the above factors, the risk of appendiceal rupture associated with a lack of private insurance was elevated at both county and other hospitals, but admission to a county hospital was an independent risk factor. In all income groups, appendiceal rupture was more likely with fee-for-service than capitated private coverage (overall odds ratio, 1.20 [95 percent confidence interval, 1.15 to 1.25]).

Conclusions Among patients with appendicitis an increased risk of ruptured appendix may be due to insurance-related delays in obtaining medical care. Both organizational and financial features of Medicaid and various types or levels of private third-party coverage may be involved. The significant association between ruptured appendix and insurance coverage after adjustment for socioeconomic differences suggests barriers to receiving medically necessary acute care that should be considered in current deliberations on health policy.

Source Information

From the Department of Family and Community Medicine, School of Medicine, University of California, San Francisco (P.B., S.E., T.B.); the Departments of Medicine and Surgery, San Francisco General Hospital Medical Center (V.M.S., W.S.); and the Department of Surgery, University of California, San Francisco (W.S.) -- all in San Francisco.

Address reprint requests to Dr. Braveman at the Department of Family and Community Medicine, University of California, San Francisco, Box 0900, San Francisco, CA 94143-0900.

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Extract | Full Text  
N Engl J Med 1995; 332:395-398, Feb 9, 1995. Correspondence

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