Better to Be Uninsured If You Need Trauma Care?

When I entered the ER as a patient in December, I wasn't seen for probably close to two hours.  As an uninsured patient at the time, I figured that was why.

But now USA Today reports that uninsured trauma patients may get better care.

A published Wednesday found that uninsured patients with severe injuries – "the kind commonly associated with car crashes, serious falls and gunshots – were significantly more likely than insured patients to be transferred out of hospitals not specializing in trauma care."

Now, I wasn't a trauma patient. I only had a broken wrist.  But I thought that was pretty interesting.

I like to watch all these medical shows -- "Untold Stories of the ER," with its dramatized cases (where everyone always gets well) and on the Oprah channel, the reality show, "New York Med" that shows you everything, the blood and guts and it's all real, not scripted.  Every once in a while a hospital on one of these shows doesn't have the appropriate equipment to treat the seriously injured patient so they ship him out.

If you're one of those lucky ones, you'll probably live.  Trauma centers save more lives. "This is one scenario where the uninsured may not be worse off," writer Kim Painter quotes lead author M. Kit Delgado, a specialist in emergency medicine at the University of Pennsylvania.

But not everyone agrees. Some other experts question the study's suggestion that hospitals choose to admit or transfer trauma patients based on insurance coverage. "They agree that it illustrates a broader problem," Painter writes. Many people with traumatic injuries are treated at community hospitals rather than regional trauma centers, despite research showing a 25% survival advantage at such centers.

But In the study, transfers occurred 45% of the time. Transfers were 14% less likely in patients with Medicaid and 11% less likely in those with private insurance than in otherwise similar patients with no insurance. Howard Mell, an emergency physician based in Cleveland who works at seven hospitals in four states, tells Painter he never knows a patient's insurance status and never has such conversations with case managers. She adds, "That's how it's supposed to work, he says, under a law that prohibits 'dumping' of uninsured patients on other hospitals. 

"I have to make the decision based on whether I have the capacity to care for the patient," Painter quotes Mell , a spokesman for the American College of Emergency Physicians.

So is it better to have insurance or not if you crash through the windshield of your car and split your head open?  It's best not to need the care in the first place, of course.  But if you do, chances are you will be sent first where you most can be saved.

Most decisions "in the heat of battle" are made by doctors trying to "do their best for the patient," Painter quotes Charles Mabry, a surgeon at the University of Arkansas. 


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