INSURANCE-RELATED DIFFERENCES IN THE RISK OF RUPTURED APPENDIX

Background. We studied differences in the incidence of appendiceal per foration in patients with acute appendicitis according to their insura nce coverage. Methods. In a retrospective analysis of hospital-dischar ge data, we examined the likelihood of ruptured appendix among adults 18 to 64 years old who were hospitalized for acute appendicitis in Cal ifornia from 1984 to 1989. Results. After controlling for age, sex, ps ychiatric diagnoses, substance abuse, diabetes, poverty, race or ethni c group, and hospital characteristics, we found that ruptured appendix was more likely among both Medicaid-covered and uninsured patients wi th appendicitis than among patients with private capitated coverage (o dds 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). Afte r adjustment for the above factors, the risk of appendiceal rupture as sociated with a lack of private in-surance was elevated at both county and other hospitals, but admission to a county hospital was an indepe ndent risk factor. In all income groups, appendiceal rupture was more likely with fee-for-service than capitated private coverage (overall o dds ratio, 1.20 [95 percent confidence interval, 1.15 to 1.25]). Concl usions. 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 vario us types or levels of private third-party coverage may be involved. Th e significant association between ruptured appendix and insurance cove rage after adjustment for socioeconomic differences suggests barriers to receiving medically necessary acute care that should be considered in current deliberations on health policy.