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The Effect of Payer Status on Utilization of Hospital Resources in Trauma Care

Peter M. Rhee, MD, MPH; David Grossman, MD, MPH; Frederick Rivara, MD, MPH; Charles Mock, MD, MPH; Gregory Jurkovich, MD; Ronald V. Maier, MD
Arch Surg. 1997;132(4):399-404. doi:10.1001/archsurg.1997.01430280073010.
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Objective:  To determine the effect of payer status on outcome and resource utilization in motor vehicle—related trauma patients.

Design:  Retrospective cohort analysis that assessed the effect of payer status on outcome and resource utilization.

Setting:  The single level I trauma center in a regionalized statewide system.

Patients:  Consecutive patients (N=3141) who were hospitalized after a motor vehicle crash during a 3-year period.

Main Outcome Measures:  The mortality rate, disposition, total hospital length of stay (LOS), total intensive care unit LOS, and total hospital charges were examined for 2 categories of payers: "commercial insurance" (commercial, labor and industry, and contract pay) and "noncommercial insurance" (Medicaid and self-pay).

Results:  After controlling for age, sex, race, and the Injury Severity Score, the payer status had no overall effect on the mortality rate, disposition, total hospital charges, total hospital LOS, or total intensive care unit LOS. However, there was a significantly (11.4%; P<.05) longer LOS for those patients with noncommercial insurance who required transfer to another facility for rehabilitation or long-term care.

Conclusions:  The utilization of hospital trauma care resources in a level I facility in a regionalized system was not associated with insurance status. Patients with noncommercial insurance who required transfer to elective long-term care facilities had a longer LOS due to delays in obtaining subsequent access. Health care policy should provide appropriate reimbursement for all aspects of regionalized trauma care systems to ensure maintenance of an egalitarian approach to care.Arch Surg. 1997;132:399-404

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