Related Experiment Videos
Hospital reimbursement for pediatric trauma care
B H Harris1, K D Bass, M D O'Brien
1Division of Pediatric Surgery, Tufts University School of Medicine, New England Medical Center, Boston, MA, USA.
Journal of Pediatric Surgery
|January 1, 1996
Summary
Pediatric trauma center reimbursement meets or exceeds costs, comparable to general surgery. Reimbursement rates for trauma patients are time-dependent, with full settlement occurring over 18 months.
Area of Science:
- Pediatric Trauma Care
- Healthcare Economics
- Hospital Reimbursement
Background:
- Pediatric trauma centers are vital but face financial sustainability concerns.
- Perceived high costs may threaten the development of these specialized centers.
Purpose of the Study:
- To evaluate actual reimbursement rates for pediatric trauma patients.
- To compare these rates with those of a general surgical population (appendectomy patients).
Main Methods:
- Retrospective review of 209 trauma patients and 37 appendectomy patients (1992-1993).
- Trauma patients categorized by Injury Severity Score (ISS): moderate (ISS ≤ 9) and serious (ISS ≥ 10).
- Analysis of hospital charges, costs, and reimbursement timelines.
Main Results:
- Appendectomy patients reimbursed at 72% of charges and 112% of costs.
- Moderately injured trauma patients reimbursed at 104% of charges and 137% of costs.
- Seriously injured trauma patients initially reimbursed at 63% of charges and 86% of costs, reaching 76% of charges and 103% of costs after 18 months.
Conclusions:
- Hospital reimbursement for Level I pediatric trauma centers exceeds 75% of charges and 100% of costs.
- Reimbursement rates are comparable to the general hospital surgical population.
- Reimbursement for pediatric trauma care is time-dependent, with full settlement achieved over an extended period.