Impact of Insurance Status on Follow-Up Care for Operative and Non-Operative Orthopedic Trauma in a Public Hospital Setting

Introduction Follow-up adherence in orthopedic trauma is crucial for identifying complications and optimizing recovery. Insurance status can influence access to necessary follow-up care, with uninsured patients often facing significant barriers. Limited research exists on the impact of insurance status on follow-up adherence in orthopedic trauma patients at public hospitals. This study investigates the role of insurance status in follow-up adherence among orthopedic trauma patients at a public hospital. Methods A retrospective review was conducted on 1,040 adult orthopedic trauma patients at a U.S. level-one trauma center over 13 months (2021–2022). Patients were classified as insured or uninsured, with uninsured further divided into “uninsured-assisted” (Hospital Card) and “uninsured-unassisted” groups. Data on demographics, operative status, first follow-up attendance, and six-month follow-up completion were analyzed. Chi-squared tests and logistic regression assessed the association between insurance status and follow-up adherence. Outcomes of patients evaluated before and after June 2021 were compared to examine the effects of the COVID-19 pandemic. Results Of 839 patients recommended for follow-up, 66.3% attended their first appointment, with no significant difference between insured (68.2%) and uninsured (63.4%) patients. However, uninsured patients were significantly more likely to be lost to follow-up at six months compared to insured patients. No differences were found between Hospital Card (local financial assistance program) and privately insured patients at six months or between COVID and post-COVID groups. Operatively managed patients had a significantly higher first-appointment attendance than non-operatively managed patients. Alcohol and tobacco use were linked to significantly lower first-appointment attendance. Discussion and Conclusion Insurance status did not impact first-appointment attendance but was associated with six-month follow-up challenges for uninsured patients without financial assistance. Our results highlight the importance of financial assistance programs as a mechanism to improve follow-up adherence for uninsured orthopedic trauma.