title: Insuring the uninsured: potential impact of Health Care Reform Act of 2010 on trauma centers.
abstract: BACKGROUND
  Viability of trauma centers is threatened by cost of care provided to patients without health insurance. The health care reform of 2010 is likely to benefit trauma centers by mandating universal health insurance by 2014. However, the financial benefit of this mandate will depend on the reimbursement provided. The study hypothesis was that compensation for the care of uninsured trauma patients at Medicare or Medicaid rates will lead to continuing losses for trauma centers.
  
  
  METHODS
  Financial data for first hospitalization were obtained from an urban Level I trauma center for 3 years (n = 6,630; 2006-2008) and linked with clinical information. Patients were grouped into five payments categories: commercial (29%), Medicaid (8%), Medicare (20%), workers' compensation (6%), and uninsured (37%). Prediction models for costs and payments were developed for each category using multiple regression models, adjusting for patient demographics, injury characteristics, complications, and survival. These models were used to predict payments that could be expected if uninsured patients were covered by different insurance types. Results are reported as net margin per patient (payments minus total costs) for each insurance type, with 95% confidence intervals, discounted to 2008 dollar values.
  
  
  RESULTS
  Patients were typical for an urban trauma center (median age of 43 years, 66% men, 82% blunt, 5% mortality, and median length of stay 4 days). Overall, the trauma center lost $5,655 per patient, totaling $37.5 million over 3 years. These losses were encountered for patients without insurance ($14,343), Medicare ($4,838), and Medicaid ($15,740). Patients with commercial insurance were profitable ($5,295) as were those with workers' compensation ($6,860). Payments for the care of the uninsured at Medicare/Medicaid levels would lead to continued losses at $2,267 to $4,143 per patient.
  
  
  CONCLUSIONS
  The health care reforms of 2010 would lead to continued losses for trauma centers if uninsured are covered with Medicare/Medicaid-type programs.
  
  
  METHODS
  Economic analysis, level II.
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas 76051, USA. shahid.shafi@baylorhealth.edu
authors.forename: Shahid
authors.initials: S
authors.lastname: Shafi
authors.forename: Gerald
authors.initials: G
authors.lastname: Ogola
authors.forename: Neil
authors.initials: N
authors.lastname: Fleming
authors.forename: Nadine
authors.initials: N
authors.lastname: Rayan
authors.forename: Rustam
authors.initials: R
authors.lastname: Kudyakov
authors.forename: Sunni A
authors.initials: SA
authors.lastname: Barnes
authors.forename: David J
authors.initials: DJ
authors.lastname: Ballard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D019458:Insurance Coverage / Q000191:economics* / Q000331:legislation & jurisprudence*; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000331:legislation & jurisprudence; D008297:Male; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000191:economics*; D014193:Trauma Centers / Q000191:economics* / Q000331:legislation & jurisprudence; D014481:United States; D014942:Workers' Compensation / Q000191:economics; D055815:Young Adult