Analysis of Hospital Trauma Center Charges for Commercially Insured Patients in the United States

Little is known about the sources of financing to offset the costs associated with operating hospital-based trauma centers (TCs). Research has documented separate trauma activation charges in hospital transparency databases, but the amounts that TCs bill to third-party payors have not been studied. We examined the association between trauma activation fees, an additional facility fee charged by TCs for trauma care, and the overall billed hospital charges between 2019 and 2022 using commercial administrative claims data for injury patients. Average hospital charges were US$41,601 (p < .001) higher for trauma injury patients relative to nontrauma injury patients. After controlling for patient, clinical, and hospital characteristics, the differential decreased to US$31,613 (p < .001) and further to US$12,793 (p < .001) after excluding the facility charge for trauma activation. Our findings indicate that TCs bill more for trauma injury patients - a premium that cannot be fully explained by patient case mix or the trauma activation charge.