AN ANALYSIS OF THE CRITICAL PROBLEM OF TRAUMA CENTER REIMBURSEMENT
AN ANALYSIS OF THE CRITICAL PROBLEM OF TRAUMA CENTER REIMBURSEMENT
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DOI：
10.1097/00005373-199107000-00007
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发表时间：
1991-07-01
影响因子：
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通讯作者：
RICHARDSON, JD
中科院分区：
文献类型：
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作者：
EASTMAN, AB;RICE, CL;RICHARDSON, JD
人们普遍认为，许多创伤中心的补偿很低，许多曾经照顾创伤受害者的医院不再这样做，主要是出于经济原因。 这个问题被归咎于没有保险和保险不足的病人，但缺乏支持这种看法的数据。 为了确定这些看法的有效性，并更好地了解创伤中心报销的性质，进行了一项调查。 将一份关于创伤中心（TC）和医院（HO）患者人群每年创伤量和报销经验的问卷邮寄给代表性但非随机选择的创伤中心。 71份调查问卷被邮寄，25份被退回（35%）。 有15个一级中心和10个二级中心; 16个在城市，7个在郊区，2个在农村。 18个中心（72%）报告说，与卫生组织相比，技术合作资金严重不足，11个中心表示，在目前的报销情况下，它们将无法继续提供目前水平的技术合作服务。 对于医疗保险患者，HO成本回收率平均为93%，但TC的回收率仅为64%。 对于医疗补助受益人，HO成本回收率平均为85%，但TC仅为49%。 31%的TC患者根本没有保险，而HO患者只有9%。 受访者报告的总损失相当于总成本的19.9%。 这项调查，虽然不代表整个美国的创伤中心，但确实表明，创伤护理资金不足的看法是有依据的，并表明这种资金不足是由逆向选择和不成比例的份额相结合造成的。 我们还描述了一种新的方法来评估和比较创伤中心的补偿。
There is a widespread perception that many trauma centers are poorly reimbursed, and many hospitals that once cared for trauma victims no longer do so, primarily for financial reasons. The problem is blamed on both uninsured and underinsured patients, but data supporting this perception are lacking. To determine the validity of these perceptions and to better understand the nature of trauma center reimbursement, a survey was conducted. A questionnaire on the volume of trauma seen annually and the reimbursement experience for trauma center (TC) and hospital (HO) patient populations was mailed to representative but nonrandomly chosen trauma centers. Seventy-one surveys were mailed and 25 were returned (35%). There were 15 Level I and 10 Level II centers; 16 were urban, seven were suburban, and two were rural. Eighteen centers (72%) reported significant underfunding of the TC in contrast to the HO, and 11 indicated that they would not be able to continue their current level of TC services with present reimbursement. For Medicare patients, HO cost recovery rates averaged 93%, but recovery rates were only 64% for TCs. For Medicaid beneficiaries, the HO cost recovery rate averaged 85%, but it was only 49% for TCs. Thirty-one percent of TC patients had no insurance coverage at all, in contrast to only 9% of HO patients. An aggregate loss equal to 19.9% of total costs was reported by respondents. This survey, while not representative of trauma centers as a whole throughout the United States, does suggest that there is a basis for the perception of underfunding of trauma care and indicates that such underfunding results from the combination of adverse selection and disproportionate share. We also describe a new method for assessing and comparing trauma center reimbursement.