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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.
Abstract
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
Author Affiliations
From the Harborview Injury Prevention Center (Drs Rhee, Grossman, Rivara, Mock, Jurkovich, and Maier) and the Departments of Surgery (Drs Rhee, Mock, Jurkovich, and Maier) and Pediatrics (Drs Grossman and Rivara), Harborview Medical Center, University of Washington, Seattle; and the Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Md (Dr Rhee).
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