title: The impact of public versus private insurance on trauma patients.
abstract: BACKGROUND
  The socioeconomic status has been associated with disparities in the incidence and mortality of traumatic injuries. However, there is a lack of studies on the level of health insurance with regard to various epidemiologic data of traumatic injuries, which this study opted to clarify.
  
  
  METHODS
  All consecutive 6595 patients admitted to a level one trauma center in 2012 and 2013 were included in this retrospective cohort study. Patients were grouped according to their health insurance status (public versus private extended health care insurance) and compared with regard to several epidemiologic variables, that is, the type of injuries, inhospital outcome, and surgical procedures.
  
  
  RESULTS
  Public insurance coverage was significantly more common than private insurance (75% versus 25%). Public insurance was associated with younger age, male sex, transfers to another hospital or mental institution, head concussions, head fractures, and increased mortality. Contrarily, patients with private insurance were more often associated with longer hospital stay, discharge to a rehabilitation clinic, fractures of the proximal humerus, and shoulder dislocations. However, there were no significant differences for the remaining majority of studied variables.
  
  
  CONCLUSIONS
  In a trauma setting, the level of insurance does not seem to play a crucial role in most types of injuries and surgical procedures in a country with a high level of obligatory health care coverage. Nonetheless, it appears that publicly insured patients are more commonly younger, males, transferred to another hospital more often, more prone to head trauma, and subject to increased mortality, whereas privately insured patients show longer hospital stays, increased transfers to rehabilitation clinics, and more fractures of the proximal humerus.
authors.affiliation: Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, University of Zürich, Zürich, Switzerland. Electronic address: thorsten.jentzsch@usz.ch.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Jentzsch
authors.affiliation: Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, University of Zürich, Zürich, Switzerland.
authors.forename: Valentin
authors.initials: V
authors.lastname: Neuhaus
authors.affiliation: Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland.
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, University of Zürich, Zürich, Switzerland.
authors.forename: Georg
authors.initials: G
authors.lastname: Osterhoff
authors.affiliation: Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, University of Zürich, Zürich, Switzerland.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Simmen
authors.affiliation: Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, University of Zürich, Zürich, Switzerland.
authors.forename: Clément M L
authors.initials: CM
authors.lastname: Werner
authors.affiliation: Office of the Medical Directorate, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Moos
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013557:Switzerland / Q000453:epidemiology; D014947:Wounds and Injuries / Q000191:economics* / Q000453:epidemiology / Q000601:surgery
keywords: Epidemiology of injuries; Level of health care insurance (public versus private extended); Mortality; Surgeries; Trauma patients