Insult to injury

Have insurance, will get proper care? Maybe not, according to a School of Medicine study.

In this study of cases of severe injuries, patients with insurance are more likely to get poor trauma care than those without. Apparently, more insured patients are held back at non-trauma hospitals instead of being sent to centers specializing in trauma, the JAMA Surgery study reveals.

The findings of the study — one of the first such population-wide analyses — are concerning, the authors say.

Perhaps emergency doctors fail to follow guidelines or recognize conditions that need extra care, suggests lead author Kit Delgado, MD. Or maybe, more disturbingly, non-trauma hospitals hold insured patients back so they can get reimbursed.

To curb such practices, these hospitals could better monitor emergency room encounters and split transfer costs with trauma centers, the authors say. Previous studies show that trauma-center care reduces the chances of a severely injured patient dying by 25 percent.

Senior author Nancy Wang, MD, earlier found such insurance-based disparities in trauma care access for children and seniors in California. “Researchers and the community should understand this trend,” she says, “so that it can be changed.”

The authors analyzed over 4,500 nationwide reported trauma cases for the study. Next they hope to figure out if and how patients’ preferences and knowledge of options affect trauma transfer decisions.

Wang is an associate professor of surgery. Delgado is a former Stanford emergency medicine instructor, now at the University of Pennsylvania.