Access to Surgical Care After Newly Acquired Insurance Enrollment.

Objective: To evaluate the association between insurance acquisition through a hospital-based linkage program and the utilization of elective and emergency surgical procedures within one year of hospitalization.

Background: Lack of insurance creates substantial barriers to elective surgical procedures, potentially leading to preventable complications and worsened outcomes. Hospital-based insurance linkage programs may help address these challenges by providing retroactive coverage, but their impact on surgical care utilization remains understudied.

Methods: We used electronic medical records and regional health information exchange data to conduct a retrospective cohort study of Pennsylvania residents aged 18-64 years who were admitted through the emergency department and were uninsured or Medicaid-insured at presentation. Insurance status was categorized as retroactively insured, Medicaid-insured, or uninsured. Multivariable logistic regression was used to compare the odds of undergoing elective, emergent, and any surgical procedure within 12 months of admission among these groups.

Results: Among 14,979 patients, elective surgery rates were 18.5% (Medicaid), 15.2% (retroactively insured), and 5.7% (uninsured) (P<0.001). After adjusting for demographic, socioeconomic, and clinical factors, retroactively insured patients had 16% lower odds of elective surgery than Medicaid patients (OR 0.84, 95% CI [0.74-0.95]; P=0.004), while uninsured patients had 68% lower odds (OR 0.32, 95% CI [0.24-0.43]; P<0.001). Emergent surgery rates were similar across groups.

Conclusions: Although patients gaining insurance through linkage had slightly lower elective surgery rates than those with pre-existing Medicaid, they underwent substantially more elective procedures than those who remained uninsured. Insurance linkage programs may help improve access to elective surgery, potentially reducing disparities and supporting health system financial sustainability.