USA TODAY International Edition
When no insurance may work for you
Study: Uninsured trauma patients often receive better care
Lacking health insurance usually means getting worse health care, but that might not be true when it comes to a traumatic injury, a new study suggests.
The study, published this past week in JAMA Surgery, found that uninsured patients with severe injuries — the kind commonly associated with car crashes, serious falls and gunshots — were significantly more likely than insured patients to be transferred out of hospitals not specializing in trauma care.
It’s most likely that those patients made their way to trauma centers, hospitals set up to handle such cases and proved to save more lives, researchers say.
“This is one scenario where the uninsured may not be worse off,” says lead author M. Kit Delgado, a specialist in emergency medicine at the University of Pennsylvania.
Some other experts question the study’s suggestion that hospitals choose to admit or transfer trauma patients based on insurance coverage. They agree that it illustrates a broader problem: Many people with traumatic injuries are treated at community hospitals rather than regional trauma centers, despite research showing a 25% survival advantage at such centers.
For the study, Delgado and colleagues reviewed records from more than 4,000 adult trauma patients younger than 65 initially treated at 636 non- trauma hospitals in 2009. About 75% of U. S. hospitals are non- trauma hospitals, and about one- third of trauma patients get initial treatment in them, Delgado says.
Guidelines from the federal Centers for Disease Control and Prevention call for most of those patients to be transferred to trauma centers after they are stabilized.
In the study, transfers occurred 45% of the time. Transfers were 14% less likely in patients with Medicaid and 11% less likely in those with private insurance than in otherwise similar patients with no insurance.
Delgado says the study does not mean hospitals used “wallet biopsies” to pick patients, though he says it is possible case managers discouraged doctors from admitting uninsured patients who could get better care elsewhere — but failed to give the same appropriate scrutiny to insured patients doctors felt they could handle.