It鈥檚 called 鈥減atient dumping鈥� 鈥� when hospitals transfer patients without insurance to public hospitals. But a new study from Stanford University has turned dumping on its head. It finds that to trauma centers if they have health insurance.
Researchers at Stanford University looked at more than 4,500 trauma cases at 636 hospitals around the country to see what happened to critically injured patients brought to emergency rooms that aren鈥檛 designated trauma centers. They found that non-trauma centers were much more likely to admit patients who had insurance, whether it was private insurance or Medicaid coverage, than to transfer them to more skilled facilities.
鈥淚t鈥檚 the opposite of the overly aggressive transfer of a poor patient,鈥� said Dr. Arthur Kellermann, the dean of the U.S. Military Medical School, and a trauma care expert who was not involved in the study. 鈥淭his is actually suggesting that patients who have coverage for critical injuries may not be getting transferred as quickly as they should be.鈥�
Getting to a designated trauma center matters for patients with serious injuries. Severely injured patients are than in a typical emergency room. It鈥檚 not just a matter of getting in the door at the closest hospital, but getting in the door at the right hospital, Dr. Kellermann said. 鈥淭hat鈥檚 the whole point of trauma centers. The expertise, the speed of response, the capacity to manage complex injuries is significantly better at major trauma centers. That鈥檚 the whole reason certain hospitals are designated trauma centers.鈥�
The study didn鈥檛 assess how patients at non-trauma centers fared. The researchers excluded patients over 65, and only looked at patients who were admitted or transferred. Dr. Kit Delgado, the study鈥檚 lead author and former Stanford emergency medicine instructor, says critically injured patients 鈥渁dmitted to hospitals that are not trauma centers are at risk for worse outcomes.鈥�
It鈥檚 unclear just who makes that decision to admit or transfer. Emergency physicians and nurses typically don鈥檛 know whether their patients are insured. But Delgado, who is now an emergency care researcher at the University of Pennsylvania, says hospital administrators often weigh in on where uninsured patients end up, and that same dynamic could help explain why non-trauma centers are reluctant to give up paying customers. 鈥淎s an emergency physician,鈥� Delgado said, 鈥測ou may get a tap on the shoulder by a case manager that suggests that you should consider transferring the patient out to a hospital where they can be taken care of and they鈥檙e willing to accept them without insurance.鈥�
The business of medicine too often dictates where patients are cared for, said Kellermann, and that includes whether a hospital admits patients or transfers them. 鈥淭hat decision should not be influenced by economics one way or the other. It should be influenced only by what鈥檚 in the best interest of patients,鈥� he said.
It鈥檚 not the first time researchers have found hospitals holding on to insured patients: low-birth-weight babies do better at high-volume neonatal intensive care units, but babies covered by insurance .
Still, there may be other reasons why patients aren鈥檛 transferred to hospitals with more expertise: Delgado is currently researching whether patients prefer to stay at their local community hospital instead of being moved to a trauma center that may be a public hospital or located in an inner-city area. If that鈥檚 the case, Delgado says hospitals need to do a better job educating patients about where the best care is available.