Tanenbaum Joseph, Reddy Susheel, Slocum John, Cantrell Colin, Butler Bennet, Lundberg Alexander, Stey Anne M
Department of Orthopedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address: https://www.twitter.com/jttanenbaum.
Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Surgery. 2025 Feb;178:108921. doi: 10.1016/j.surg.2024.10.012. Epub 2024 Dec 6.
Observational studies reported that nontrauma/low-level trauma centers less frequently transferred insured injured patients to high-level centers. The dependent coverage provision of the Affordable Care Act was a natural experiment expanding insurance eligibility in 2010 by allowing young adults to remain on their parents' insurance until age 26 years old. The objective was to determine whether expanded insurance eligibility reduced interhospital transfers.
This observational, retrospective cohort study of the 2007-2013 National Trauma Data Bank used a difference-in-differences design to compare the change in interhospital transfer rates before and after dependent coverage provision implementation between dependent coverage provision-eligible (aged 19-25 years) and dependent coverage provision-ineligible (aged 27-34 years) injured patients. The exposure of interest was the dependent coverage provision. The main outcome was yearly rate of interhospital transfer. Least-squares linear regression modeled interhospital transfer rates and quantified association with the age-based dependent coverage provision eligibility binary interaction term in the pre-dependent coverage provision versus post-dependent coverage provision time periods.
A total of 535,036 dependent coverage provision-eligible and 431,462 dependent coverage provision-ineligible patients were identified. The median Injury Severity Score was 6.0 (interquartile range = 4.0-13.0) for both cohorts. Private insurance rates increased from 28.1% to 38.7% among the dependent coverage provision-eligible cohort and from 27.0% to 30.5% among the older cohort between the pre-dependent coverage provision to post-dependent coverage provision time period. The average yearly interhospital transfer rate was not significantly different between the cohorts in the pre-dependent coverage provision (2.3% lower among dependent coverage provision-eligible) and the post-dependent coverage provision time periods (2.9% lower among dependent coverage provision-eligible). Difference-in-differences analysis revealed nonsignificant 14.6 fewer transfers/10,000 patients (95% confidence interval = 33.7 fewer to 4.4 more transfers/10,000 patients).
Policies expanding insurance eligibility do not reduce interhospital transfers in a mature trauma system.
观察性研究报告称，非创伤/低级别创伤中心将参保受伤患者转至高级别中心的频率较低。《平价医疗法案》的受抚养人保险条款是一项自然实验，通过允许年轻人在26岁之前继续享受其父母的保险，于2010年扩大了保险资格范围。目的是确定扩大保险资格范围是否减少了医院间的转诊。
这项对2007 - 2013年国家创伤数据库进行的观察性、回顾性队列研究采用了差异分析设计，以比较在实施受抚养人保险条款之前和之后，符合受抚养人保险条款资格（年龄在19 - 25岁之间）和不符合受抚养人保险条款资格（年龄在27 - 34岁之间）的受伤患者之间医院间转诊率的变化。感兴趣的暴露因素是受抚养人保险条款。主要结局是医院间转诊的年发生率。最小二乘线性回归对医院间转诊率进行建模，并量化在实施受抚养人保险条款之前与之后的时间段内，基于年龄的受抚养人保险条款资格二元交互项之间的关联。
共识别出535,036名符合受抚养人保险条款资格的患者和431,462名不符合受抚养人保险条款资格的患者。两个队列的损伤严重程度评分中位数均为6. (四分位间距 = 4.0 - 13.0)。在实施受抚养人保险条款之前到之后的时间段内，符合受抚养人保险条款资格队列中的私人保险费率从28.1%升至38.7%，年龄较大队列中的私人保险费率从27.0%升至30.5%。在实施受抚养人保险条款之前的时间段内，两个队列之间的年均医院间转诊率无显著差异（符合受抚养人保险条款资格的患者低2.3%），在实施受抚养人保险条款之后的时间段内也是如此（符合受抚养人保险条款资格的患者低2.9%）。差异分析显示，每10,000名患者的转诊减少14.6例无显著差异（95%置信区间为每10,000名患者减少33.7例至增加4.4例）。
在成熟的创伤系统中，扩大保险资格范围的政策不会减少医院间的转诊。
