title: The effect of payer status on utilization of hospital resources in trauma care.
abstract: OBJECTIVE
  To determine the effect of payer status on outcome and resource utilization in motor vehicle-related trauma patients.
  
  
  METHODS
  Retrospective cohort analysis that assessed the effect of payer status on outcome and resource utilization.
  
  
  METHODS
  The single level I trauma center in a regionalized statewide system.
  
  
  METHODS
  Consecutive patients (N = 3141) who were hospitalized after a motor vehicle crash during a 3-year period.
  
  
  METHODS
  The mortality rate, disposition, total hospital length of stay (LOS), total intensive care unit LOS, and total hospital charges were examined for 2 categories of payers: "commercial insurance" (commercial, labor and industry, and contract pay) and "noncommercial insurance" (Medicaid and self-pay).
  
  
  RESULTS
  After controlling for age, sex, race, and the Injury Severity Score, the payer status had no overall effect on the mortality rate, disposition, total hospital charges, total hospital LOS, or total intensive care unit LOS. However, there was a significantly (11.4%; P < .05) longer LOS for those patients with noncommercial insurance who required transfer to another facility for rehabilitation or long-term care.
  
  
  CONCLUSIONS
  The utilization of hospital trauma care resources in a level I facility in a regionalized system was not associated with insurance status. Patients with noncommercial insurance who required transfer to elective long-term care facilities had a longer LOS due to delays in obtaining subsequent access. Health care policy should provide appropriate reimbursement for all aspects of regionalized trauma care systems to ensure maintenance of an egalitarian approach to care.
authors.affiliation: Harborview Injury Prevention Center, University of Washington, Seattle, USA.
authors.forename: P M
authors.initials: PM
authors.lastname: Rhee
authors.forename: D
authors.initials: D
authors.lastname: Grossman
authors.forename: F
authors.initials: F
authors.lastname: Rivara
authors.forename: C
authors.initials: C
authors.lastname: Mock
authors.forename: G
authors.initials: G
authors.lastname: Jurkovich
authors.forename: R V
authors.initials: RV
authors.lastname: Maier
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*