title: Public hospital-based level I trauma centers: financial survival in the new millennium.
abstract: BACKGROUND
  The medical benefits of trauma centers have been well documented; studies have reported substantial financial losses attributed to trauma care. This study demonstrates the dependence of Level I trauma centers on Disproportionate Share Hospital (DSH) governmental funds and tax dollars. Furthermore, specific injury groups have greater dependence on these funds.
  
  
  METHODS
  Records of 553 trauma patients admitted to a public urban Level I trauma center during a 6-month period were reviewed. Patients were grouped according to blunt, penetrating, and thermal injuries. Data for each group included charges, costs, payments, and the source of reimbursement. Profit and loss margins were compared with and without government funds.
  
  
  RESULTS
  With diminished DSH funds and tax dollars, a net loss over $2.1 million was incurred. The greatest disparity originates from Medicaid, self-pay, and prisoner patient groups. Inclusion of government funds provided a positive return of over $600,000.
  
  
  CONCLUSIONS
  The financial stability of urban public Level I trauma centers without additional funding is tenuous because of a high proportion of uninsured and underinsured patients. Government tax dollars and DSH funds are required for their continued solvency.
authors.affiliation: Department of Surgery, Trauma Surgery Division, Indiana University School of Medicine, Indianapolis 46202, USA. djselzer@aol.com
authors.forename: D
authors.initials: D
authors.lastname: Selzer
authors.forename: G
authors.initials: G
authors.lastname: Gomez
authors.forename: L
authors.initials: L
authors.lastname: Jacobson
authors.forename: T
authors.initials: T
authors.lastname: Wischmeyer
authors.forename: R
authors.initials: R
authors.lastname: Sood
authors.forename: T
authors.initials: T
authors.lastname: Broadie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005380:Financing, Government / Q000191:economics*; D005544:Forecasting; D017721:Hospital Costs / Q000639:trends; D006779:Hospitals, Public / Q000191:economics*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D014193:Trauma Centers / Q000191:economics*; D017664:Uncompensated Care / Q000191:economics; D014481:United States