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Payer status: the unspoken triage criterion
A B Nathens1, R V Maier, M K Copass
1Division of General and Trauma Surgery, Department of Surgery, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Seattle, WA 98104-2499, USA. anathans@u.washington.edu
The Journal of Trauma
|May 24, 2001
Summary
Patients without commercial insurance are more likely to be transferred between trauma centers, indicating an inequitable financial burden within trauma systems. This highlights the need for fair reimbursement strategies to ensure trauma system sustainability and equitable care.
Area of Science:
- Health Services Research
- Trauma Surgery
- Healthcare Economics
Background:
- The cost of uncompensated trauma care impedes trauma system development.
- Trauma center designation can lead to financial burdens due to underinsured patients.
- Concerns about reimbursement may influence interhospital transfers, potentially compromising system effectiveness.
Purpose of the Study:
- To investigate whether insurance status influences interhospital transfer decisions in a mature trauma system.
- To determine if financial considerations, rather than solely medical necessity, drive transfers.
Main Methods:
- Comparison of trauma patients receiving care at Level III/IV centers versus those transferred to a Level I center.
- Classification of insurance status as commercial or noncommercial.
- Logistic regression analysis to identify independent predictors of transfer, adjusting for injury severity.
Main Results:
- Only 12% of patients initially evaluated at Level III/IV centers were transferred, reflecting effective triage.
- Complex injuries, younger age, male gender, and insurance status were associated with increased transfer likelihood.
- Patients without commercial insurance were 2.4 times more likely to be transferred to a Level I facility, independent of injury severity.
Conclusions:
- Insurance status significantly impacts decisions regarding transfer to higher levels of trauma care.
- The financial burden within trauma systems may be inequitably distributed.
- Disproportionate reimbursement strategies are needed to support regional referral centers and ensure trauma system sustainability.