Bazzoli G J, Meersman P J, Chan C
Hospital Research and Educational Trust, Chicago, Illinois 60606, USA.
J Trauma. 1996 Nov;41(5):876-85. doi: 10.1097/00005373-199611000-00021.
To examine hospital, trauma system, and reimbursement factors that offset the financial burdens of trauma care delivery and to assess how proposed Medicaid and Medicare budget cuts may affect the ability of hospitals to alleviate financial pressures related to trauma care delivery.
In-depth interviews and data collection for trauma centers in 12 metropolitan areas with populations of 1 million or more.
Seventy trauma centers in these large urban communities that indicated a continuing commitment to providing trauma services for the foreseeable future.
Hospital, trauma system, and reimbursement characteristics that distinguish hospitals that are better able to alleviate the financial burdens of indigent trauma care and a financial analysis that assesses payment adequacy for different payers and overall financial outcomes.
Data from a variety of sources were obtained to measure the factors that affect the operation and financing of trauma centers: published and unpublished hospital data from the American Hospital Association; trauma center level, length of operation, and the availability of alternative centers from a recently published study; Health Care Financing Administration data on Medicare and Medicaid program characteristics; automobile insurance requirements; and patient discharge data. Most data are reflective of 1992.
Public hospitals, teaching hospitals, and institutions receiving supplemental indigent care payments appear to be best able to mitigate the financial burdens of uncompensated trauma care, especially those with moderate indigent care loads. A detailed financial analysis found that private hospitals with trauma centers were near break-even in 1992 for trauma care delivery and public hospitals experienced financial losses. Proposals to reduce Medicaid and Medicare would create substantial reductions in hospital payments for hospital-wide patient care and trauma patients specifically.
Proposed Medicaid and Medicare payment cuts are likely to eliminate the delicate financial balance that many urban hospitals have achieved in providing trauma care. The erosion in funding from public programs may portend a new wave of trauma center closures as hospitals seek to deal with reduced reimbursement by eliminating unprofitable services.
研究抵消创伤护理交付财务负担的医院、创伤系统和报销因素，并评估拟议的医疗补助和医疗保险预算削减可能如何影响医院缓解与创伤护理交付相关财务压力的能力。
对12个人口达100万或以上的大都市地区的创伤中心进行深入访谈和数据收集。
这些大型城市社区中的70家创伤中心，它们表示在可预见的未来将继续致力于提供创伤服务。
区分能够更好地减轻贫困创伤护理财务负担的医院的医院、创伤系统和报销特征，以及评估不同支付方支付充足性和总体财务结果的财务分析。
从各种来源获取数据，以衡量影响创伤中心运营和融资的因素：美国医院协会公布和未公布的医院数据；最近一项研究中的创伤中心级别、运营时长和替代中心的可用性；医疗保健财务管理局关于医疗保险和医疗补助计划特征的数据；汽车保险要求；以及患者出院数据。大多数数据反映的是1992年的情况。
公立医院、教学医院以及接受补充贫困护理支付的机构似乎最有能力减轻无偿创伤护理的财务负担，尤其是那些贫困护理负担适中的机构。详细的财务分析发现，设有创伤中心的私立医院在1992年创伤护理交付方面接近收支平衡，而公立医院则出现了财务亏损。削减医疗补助和医疗保险的提议将大幅减少医院针对全院患者护理以及特别是创伤患者的支付。
拟议的医疗补助和医疗保险支付削减可能会打破许多城市医院在提供创伤护理方面所实现的脆弱财务平衡。公共项目资金的减少可能预示着新一轮创伤中心关闭潮，因为医院试图通过取消无利可图的服务来应对报销减少的情况。
