Triage and Admission of Burn Patients Based on Race and Payer

For-profit burn centers may prioritize commercially insured burn patients, exacerbating disparities for Medicaid (Medi-Cal) and uninsured patients who are more often racial minorities. We hypothesize that for-profit burn centers accept fewer burn transfers with Medi-Cal compared to safety-net and nonprofit centers.

California's all-payer database was queried from 2009 to 2019 to evaluate emergency-department-to-inpatient transfers for all burn patients within the state. The proportion of transfers with Medi-Cal payer was compared relative to profit status, safety-net status, and trauma center status. The likelihood of a burn transfer being accepted to for-profit center was modeled with logistic regression, adjusting for burn severity and demographics.

Among 5728 ED transfers, 89% went to nonprofit centers. Medi-Cal was the primary payer in 37.3% of transfers to nonprofit centers versus 24.0% to for-profit centers (P < .001). Medi-Cal payer (aOR 95% CI 0.49-0.76), Black race (aOR 95% CI 0.36-0.73), and Hispanic race (aOR 0.51-0.77) were all independently associated with reduced odds of transfer to for-profit burn centers. Profit status was negatively associated with the proportion of Medi-Cal transfers, while trauma center status and safety-net center status were not correlated. There was an overall increase in the proportion of Medi-Cal patients treated at nonprofit (21.8%) and for-profit (16.48%) centers over the study period.

Disparities persist in burn care access by race, ethnicity, and insurance status. Nonprofit centers more frequently serve Medi-Cal and minority patients, while for-profit centers appear to demonstrate a potential preference for caring for commercially insured, White patients.