Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
J Surg Res. 2013 Sep;184(1):444-9. doi: 10.1016/j.jss.2013.05.068. Epub 2013 Jun 10.
Several studies have described the burden of trauma care, but few have explored the economic burden of trauma inpatient costs from a payer's perspective or highlighted the differences in the average costs per person by payer status. The present study provides a conservative inpatient national trauma cost estimate and describes the variation in average inpatient trauma cost by payer status.
A retrospective analysis of patients who had received trauma care at hospitals in the Nationwide Inpatient Sample from 2005-2010 was conducted. Our sample patients were selected using the appropriate "International Classification of Diseases, Ninth Revision, Clinical Modification" codes to identify admissions due to traumatic injury. The data were weighted to provide national population estimates, and all cost and charges were converted to 2010 US dollar equivalents. Generalized linear models were used to describe the costs by payer status, adjusting for patient characteristics, such as age, gender, and race, and hospital characteristics, such as location, teaching status, and patient case mix.
A total of 2,542,551 patients were eligible for the present study, with the payer status as follows: 672,960 patients (26.47%) with private insurance, 1,244,817 (48.96%) with Medicare, 262,256 (10.31%) with Medicaid, 195,056 (7.67%) with self-pay, 18,506 (0.73%) with no charge, and 150,956 (5.94%) with other types of insurance. The estimated yearly trauma inpatient cost burden was highest for Medicare at $17,551,393,082 (46.79%), followed by private insurance ($10,772,025,421 [28.72%]), Medicaid ($3,711,686,012 [9.89%], self-pay ($2,831,438,460 [7.55%]), and other payer types ($2,370,187,494 [6.32%]. The estimated yearly trauma inpatient cost burden was $274,598,190 (0.73%) for patients who were not charged for their inpatient trauma treatment. Our adjusted national inpatient trauma yearly costs were estimated at $37,511,328,659 US dollars. Privately insured patients had a significantly higher mean cost per person than did the Medicare, Medicaid, self-pay, or no charge patients.
The results of the present study have demonstrated that the distribution of trauma burden across payers is significantly different from that of the overall healthcare system and suggest that although the burden of trauma is high, the burden of self-pay or nonreimbursed inpatient services is actually lower than that of overall medical care.
已有多项研究描述了创伤护理的负担，但很少有研究从支付方的角度探讨创伤住院费用的经济负担，也很少有研究强调按支付方身份划分的人均平均住院创伤费用的差异。本研究提供了一个保守的全国创伤住院费用估计，并描述了按支付方身份划分的平均创伤住院费用的变化。
对 2005-2010 年全国住院患者样本（NIS）中接受创伤护理的患者进行回顾性分析。我们的样本患者使用适当的“国际疾病分类，第九修订版，临床修正”代码选择，以确定因创伤性损伤而入院的患者。数据经过加权处理，以提供全国人口估计值，所有费用和收费均转换为 2010 年美元等值。使用广义线性模型按支付方身份描述费用，同时调整患者特征（如年龄、性别和种族）和医院特征（如位置、教学状态和患者病例组合）。
共有 2542551 名患者符合本研究条件，支付方身份如下：私人保险患者 672960 人（26.47%），医疗保险患者 1244817 人（48.96%），医疗补助患者 262256 人（10.31%），自付患者 195056 人（7.67%），无费用患者 18506 人（0.73%），其他类型保险患者 150956 人（5.94%）。医疗保险的年创伤住院费用负担最高，为 17551393082 美元（46.79%），其次是私人保险（10772025421 美元[28.72%]），医疗补助（3711686012 美元[9.89%]），自付（2831438460 美元[7.55%]）和其他支付类型（2370187494 美元[6.32%]）。未对其创伤住院治疗收取费用的患者的年创伤住院费用负担估计为 274598190 美元（0.73%）。私人保险患者的人均费用明显高于医疗保险、医疗补助、自付或无费用患者。
本研究结果表明，创伤负担在支付方之间的分布与整个医疗保健系统显著不同，这表明尽管创伤负担很高，但自付或未报销的住院服务负担实际上低于整体医疗保健负担。
