Health Insurance and Trauma Outcomes: The Impact of Coverage on Survival and Recovery in Craniomaxillofacial Injuries

Introduction Health disparities, particularly those related to insurance status, significantly impact trauma outcomes. Craniomaxillofacial (CMF) trauma patients without insurance often experience worse outcomes due to limited access to care and delayed treatment. This study examines the effects of insurance coverage on outcomes such as length of stay (LOS), survival, and surgical site infections (SSIs) among CMF trauma patients in Puerto Rico. Methods An institutional review board-approved retrospective analysis was conducted on 1,165 CMF trauma patients treated at the Puerto Rico Medical Center's Department of Trauma from January 2018 to October 2022. Patient demographics, trauma type, insurance coverage, and outcomes were abstracted. Patients were categorized by insurance status: government-only, private-only, government + private, and uninsured. Statistical analyses, including ANOVA, chi-square tests, and t-tests, were performed to assess the relationships between insurance status and LOS, survival, operative status, and SSI. Results Most patients (n = 849, 72.9%) had government insurance only, 60 (5.2%) had government + private, 141 (12.1%) had private only, and 99 (8.5%) were uninsured. Motor vehicle accidents were the leading cause of injury (n = 575, 49.3%). Uninsured patients had shorter LOS (mean 12.43 days) compared to those with government (20.30 days) or private insurance (16.88 days; p = 0.02). There were 84 (9.9%) deaths in the government-only insurance group, 21 (14.9%) in the private-only insurance group, 10 (16.7%) in the government + private insurance group, and 20 (20.2%) in the uninsured group (p = 0.02). While uninsured patients were less likely to undergo surgery, there were no statistically significant differences in operative rates (p = 0.355) or SSI among insurance groups (p = 0.847). Conclusions This study highlights potential disparities in outcomes for CMF trauma patients in Puerto Rico based on insurance status. Government-insured patients had longer LOS but lower mortality, while uninsured patients experienced shorter stays and higher mortality, suggesting potential undertreatment. Expanding insurance coverage and improving follow-up care for uninsured populations could help address these disparities. Further research is needed to identify systemic factors, identify reasons for lack of insurance, and inform equitable trauma care policies.