A recent research article from the LAC+USC Level I trauma center in Los Angeles looked at the impact of insurance vs no insurance on outcomes after trauma. They reviewed 8 years of admissions starting in 1998. The outcomes analyzed included mortality, operative procedures, radiographic studies, and length of stay. Nearly 30,000 admission records were reviewed.

Some interesting findings:

• Insured patients were generally older, victims of blunt trauma, and were significantly more severely injured
• More procedures and radiographic studies were performed in the insured group (may be due to severity of injury)
• ICU length of stay was longer in the insured patients (may be due to severity of injury)
• Mortality was increased in uninsured patients. This difference was most pronounced in African American and Hispanic patients

The relationship between insurance status and access to healthcare has been investigated by numerous groups, but generally in the context of access to health resources. The major effect of lacking insurance in those studies is decreased access and subsequently poorer general health. 

The current study looked at a new population: trauma patients at an urban, county-based Level I trauma center that provides equal access to care regardless of payor status. In theory, insurance status has no bearing on access in these patients. The most notable finding was that uninsured patients had a significantly higher mortality despite younger age and lower injury severity. This was most pronounced in African American and Hispanic patients. 

The reasons for these disparities is unclear. Perhaps lack of access to regular healthcare resulted in nutritional problems or disorders due to alcohol or drug use. There may also be a relationship to an increased involvement in penetrating trauma. 

Overall, the relationship between insurance status and outcome after trauma is complex. Access to basic healthcare coverage may affect chronic health status and the ability to survive serious injury. It may also be an indicator of other factors that have not yet been determined. It certainly provides food for thought as the country increases access to basic healthcare for people who have not previously been able to obtain it.

Reference: J Trauma 68(1):211-216, 2010.