Eastman A B, Rice C L, Bishop G, Richardson J D
Scripps Memorial Hospital, La Jolla, CA 92038-0028.
J Trauma. 1991 Jul;31(7):920-5; discussion 925-6. doi: 10.1097/00005373-199107000-00007.
There is a widespread perception that many trauma centers are poorly reimbursed, and many hospitals that once cared for trauma victims no longer do so, primarily for financial reasons. The problem is blamed on both uninsured and underinsured patients, but data supporting this perception are lacking. To determine the validity of these perceptions and to better understand the nature of trauma center reimbursement, a survey was conducted. A questionnaire on the volume of trauma seen annually and the reimbursement experience for trauma center (TC) and hospital (HO) patient populations was mailed to representative but nonrandomly chosen trauma centers. Seventy-one surveys were mailed and 25 were returned (35%). There were 15 Level I and 10 Level II centers; 16 were urban, seven were suburban, and two were rural. Eighteen centers (72%) reported significant underfunding of the TC in contrast to the HO, and 11 indicated that they would not be able to continue their current level of TC services with present reimbursement. For Medicare patients, HO cost recovery rates averaged 93%, but recovery rates were only 64% for TCs. For Medicaid beneficiaries, the HO cost recovery rate averaged 85%, but it was only 49% for TCs. Thirty-one percent of TC patients had no insurance coverage at all, in contrast to only 9% of HO patients. An aggregate loss equal to 19.9% of total costs was reported by respondents. This survey, while not representative of trauma centers as a whole throughout the United States, does suggest that there is a basis for the perception of underfunding of trauma care and indicates that such underfunding results from the combination of adverse selection and disproportionate share. We also describe a new method for assessing and comparing trauma center reimbursement.
人们普遍认为，许多创伤中心的报销费用很低，而且许多曾经收治创伤患者的医院现在不再这么做了，主要是出于经济原因。这个问题被归咎于未参保和参保不足的患者，但缺乏支持这一观点的数据。为了确定这些观点的正确性，并更好地了解创伤中心报销的本质，我们进行了一项调查。一份关于每年创伤病例数量以及创伤中心（TC）和医院（HO）患者群体报销情况的问卷被邮寄给了具有代表性但并非随机挑选的创伤中心。共邮寄了71份调查问卷，25份被退回（35%）。其中有15个一级中心和10个二级中心；16个位于城市，7个位于郊区，2个位于农村。18个中心（72%）报告称，与医院相比，创伤中心资金严重不足，11个中心表示，按照目前的报销水平，他们将无法维持当前的创伤中心服务水平。对于医疗保险患者，医院的成本回收率平均为93%，但创伤中心仅为64%。对于医疗补助受益人，医院的成本回收率平均为85%，但创伤中心仅为49%。31%的创伤中心患者完全没有保险，而医院患者中这一比例仅为9%。受访者报告的总损失相当于总成本的19.9%。这项调查虽然不能代表美国所有的创伤中心，但确实表明人们认为创伤护理资金不足是有依据的，并且表明这种资金不足是逆向选择和不成比例份额共同作用的结果。我们还描述了一种评估和比较创伤中心报销情况的新方法。
