From the Section of Trauma and Acute Care Surgery, Department of Surgery (C.M.R., T.G.W., L.M.K., L.T., D.A.S., K.L.S.), Stanford University, Stanford, California.
J Trauma Acute Care Surg. 2018 Jun;84(6):876-884. doi: 10.1097/TA.0000000000001832.
Traumatic injuries result in a significant disruption to patients' lives, including their ability to work, which may place patients at risk of losing insurance coverage. Our objective was to evaluate the impact of injury on insurance status. We hypothesized that trauma patients with ongoing health needs experience changes in coverage.
We used the Nationwide Readmission Database (2013-2014), a nationally representative sample of readmissions in the United States. We included patients aged 27 years to 64 years admitted with any diagnosis of trauma with at least one readmission within 6 months. Patients on Medicare and with missing payer information were excluded. The primary outcome was payer status.
57,281 patients met inclusion criteria, 11,006 (19%) changed insurance payer at readmission. Of these, 21% (n = 2,288) became uninsured, 25% (n = 2,773) gained coverage, and 54% (n = 5,945) switched insurance. Medicaid and Medicare gained the largest fraction of patients (from 16% to 30% and 0% to 18%, respectively), with a decrease in private payer coverage (37% to 17%). In multivariate analysis, patients who were younger (27-35 years vs. 56-64 years; odds ratio [OR], 1.30; p < 0.001); lived in a zip code with average income in the lowest quartile (vs. the highest quartile; OR, 1.37; p < 0.001); and had three or more comorbidities (vs. none; OR, 1.61; p < 0.001) were more likely to experience a change in insurance.
Approximately one fifth of trauma patients who are readmitted within 6 months of their injury experience a change in insurance coverage. Most switch between insurers, but nearly a quarter lose their insurance. The government adopts a large fraction of these patients, indicating a growing reliance on government programs like Medicaid. Trauma patients face challenges after injury, and a change in insurance may add to this burden. Future policy and quality improvement initiatives should consider addressing this challenge.
Epidemiologic, level III.
创伤性损伤会严重扰乱患者的生活，包括其工作能力，这可能使患者面临失去保险覆盖的风险。我们的目的是评估损伤对保险状况的影响。我们假设有持续健康需求的创伤患者的保险覆盖情况会发生变化。
我们使用了全国再入院数据库（2013-2014 年），这是一个来自美国的再入院的全国代表性样本。我们纳入了年龄在 27 岁至 64 岁之间、因任何创伤诊断而入院且在 6 个月内至少有一次再入院的患者。排除了医疗保险和无支付方信息的患者。主要结局是支付方状态。
57281 名患者符合纳入标准，其中 11006 名（19%）在再入院时改变了保险支付方。其中，21%（n=2288）成为无保险者，25%（n=2773）获得了保险覆盖，54%（n=5945）更换了保险。医疗补助和医疗保险获得了最大比例的患者（分别从 16%增加到 30%和从 0%增加到 18%），而私人支付方的保险覆盖范围减少（从 37%减少到 17%）。多变量分析显示，年龄较轻（27-35 岁比 56-64 岁；比值比[OR]，1.30；p<0.001）；居住在平均收入处于最低四分位数的邮政编码（与最高四分位数相比；OR，1.37；p<0.001）；有三种或更多合并症（与无合并症相比；OR，1.61；p<0.001）的患者更有可能经历保险变化。
大约五分之一在受伤后 6 个月内再次入院的创伤患者经历了保险覆盖范围的变化。大多数人在保险公司之间转换，但近四分之一的人失去了保险。政府接纳了这些患者中的很大一部分，表明对医疗补助等政府项目的依赖程度不断增加。创伤患者在受伤后面临挑战，保险变化可能会增加这种负担。未来的政策和质量改进举措应考虑解决这一挑战。
流行病学，三级。
