Insured patients less likely to receive trauma care at designated trauma center than uninsured

Insured patients are less likely to receive trauma care at a designated trauma center than uninsured patients, according to a recent study.

The study, which analyzed 19,312 emergency department encounters at 636 hospitals, noted the disparity, in which insured patients were more likely to be taken to a local hospital instead.

Trauma centers tend to treat more uninsured patients from inner-city neighborhoods, but by missing out on those who are insured, they are losing out on significant cash flow, the researchers said. Even more importantly, insured patients are losing out as well, since receiving care in a trauma center reduces risk of death by 25 percent for people with complex injuries.

"It suggests kind of a reverse disparity," M. Kit Delgado, lead author of the study and an emergency physician at a trauma center in the Philadelphia region, told The Inquirer.

The new study found that patients with insurance were 10 to 14 percent more likely than uninsured patients to be admitted to a hospital rather than be transferred to a trauma center. Still, Delgado doubts any kind of foul play.

"I don't think there is anything malicious going on," Delgado said. "Physicians are making decisions for the most part based on what they think would be best for the patient."

One surgeon from the University of Arkansas disagreed with the study's conclusion.

"Do financial factors have a role in how patients are treated and transferred about? Sure they do," said Charles D. Mabry. "But, I believe that there were other factors in this study that had greater influence on where trauma patients were treated." He noted, for example, that the type of injury and capability of the admitting hospital might also play a role.

The authors agree that those factors are significant, and the Pennsylvania research team is following up with three additional studies. But they note if the data still indicates a disparity, the health care system may need to implement a "shared reimbursement scheme" that would pay initially both the hospital and trauma center, eliminating any possible monetary concerns in their decisions for admittance.