Rodriguez Jorge L, Christmas A Britton, Franklin Glenn A, Miller Frank B, Richardson J David
Department of Surgery, University of Louisville, Kentucky 40292, USA.
J Trauma. 2005 Jul;59(1):1-5; discussion 5-7. doi: 10.1097/01.ta.0000171454.91359.d8.
In the last 10 years, trauma/critical care has become less attractive because of the decreasing surgical caseload, the nocturnal work hours, and the economics of the practice. Nevertheless, during the same period, the number of verified trauma centers has significantly increased. This study assesses the economic drive behind this dichotomy.
Over a 1-year period, we collected financial data on 1,907 trauma patients for both Level I trauma centers and trauma/critical care surgeons. Financial data, including payor source, cost, reimbursement, margin, and reimbursement-to-charge and reimbursement-to-direct cost ratios, were calculated.
For commercial- and government-insured patients, the reimbursement-to-direct cost ratio was 2-and 35-fold greater, respectively, for the trauma centers than for the trauma/critical care surgeons. For uninsured patients, the addition of local government funds allowed the trauma center to cover direct cost with no margin. In contrast, even with the addition of supplemental salary dollars from the institution, for every dollar in direct cost generated by the trauma/critical care surgeons in caring for uninsured patients, they recovered 55 cents, or a loss of 45 cents per direct cost dollar spent.
The economic dichotomy that exists between trauma centers and trauma/critical surgeons is significant. It drives institutional growth and, at the same time, discourages surgeons from entering the subspecialty. As physician reimbursement decreases and the number of uninsured patients increases, this economic dichotomy will amplify. Over the next decade, without a significant adjustment, the subspecialty is in danger of extinction.
在过去十年中，由于手术病例数量减少、夜间工作时间以及执业的经济因素，创伤/重症监护领域的吸引力有所下降。然而，在同一时期，经认证的创伤中心数量却显著增加。本研究评估了这种二分法背后的经济驱动因素。
在一年的时间里，我们收集了一级创伤中心和创伤/重症监护外科医生治疗的1907例创伤患者的财务数据。计算了财务数据，包括付款方来源、成本、报销、利润以及报销与收费比率和报销与直接成本比率。
对于商业保险和政府保险患者，创伤中心的报销与直接成本比率分别比创伤/重症监护外科医生高2倍和35倍。对于未参保患者，当地政府资金的补充使创伤中心能够在无利润的情况下覆盖直接成本。相比之下，即使加上机构提供的补充薪资，创伤/重症监护外科医生在治疗未参保患者时，每产生1美元的直接成本，只能收回55美分，即每花费1美元直接成本就损失45美分。
创伤中心与创伤/重症外科医生之间存在的经济二分法十分显著。它推动了机构的发展，同时也阻碍了外科医生进入该亚专业领域。随着医生报销费用的减少和未参保患者数量的增加，这种经济二分法将加剧。在未来十年，如果不进行重大调整，该亚专业领域面临灭绝的危险。
