Insurance Coverage Status Affects Mortality Rate in Pediatric Trauma Patients

Differences between private insurance, public insurance, and no insurance may
determine quality of treatment

BOSTON, Nov. 2 /PRNewswire-USNewswire/ -- A study led by Heather Rosen, MD,
MPH, research fellow in the Department of Plastic Surgery at Children's
Hospital Boston and Harvard Medical School, found that uninsured children were
over three times more likely to die from their trauma-related injuries than
children who were commercially insured, after adjustment for other factors
such as age, gender, race, injury severity and injury type in an analysis of
data from the National Trauma Data Bank. Moreover, publicly-insured children
were 1.19 times more likely to die from trauma when compared with
commercially-insured children.

According to the federal Emergency Medical Treatment and Active Labor Act
(EMTALA), all hospitals are required to treat patients until they are
medically stable, regardless of insurance status. "We have this idea that
everyone is treated equally, yet the mortality rate after trauma among
uninsured children is much higher when compared to children with commercial
insurance," says Rosen.

The study, involving researchers from Children's, Harvard Medical School, and
Brigham and Women's Hospital, collected and analyzed data from the National
Trauma Data Bank, a consortium of more than 900 trauma centers across the
country.

The researchers examined data from 174,921 trauma patients aged 17 years and
younger. Patients were divided into three groups: uninsured, publicly insured,
and commercially insured.

After adjusting for factors such as race, age, gender, injury type and injury
severity, results showed that uninsured trauma patients were over three times
more likely to die after trauma than patients who were commercially insured by
plans such as Blue Cross/Blue Shield and worker's compensation. Furthermore,
patients with public insurance, including Medicaid and the State Children's
Health Insurance Program (SCHIP), were 1.19 times more likely to die than
commercially insured patients.

Because the study was retrospective, the researchers cannot say definitively
why insurance status may affect mortality rate in spite of EMTALA. "This paper
provokes more questions than it answers," says Rosen, who is currently doing
her residency in general surgery at the University of Southern California's
Keck School of Medicine. "Should we be more vigilant about investigating
whether EMTALA laws are being violated? Is this happening more often than we
care to admit?"

The researchers speculate about several possible explanations for their
findings. One is that trauma patients with public insurance or no insurance
may be transferred from one hospital to another, causing a delay in definitive
treatment. Uninsured patients may also undergo fewer medical tests, leading to
inadequate diagnoses or missed injuries. In addition, if uninsured patients do
not speak English as their first language or are less educated overall, they
may be less able to communicate with medical providers about their medical
history and quality of care after sustaining an injury.

"This study suggests that there may be a direct effect of possessing
insurance. We need to work harder to get to the point where every person has
access to health care in this country," Rosen says.

Because emergency trauma treatment should theoretically begin before providers
know a patient's insurance status, researchers insist that further
investigation is needed to determine why these health disparities exist. For
the future, Rosen would like to conduct a prospective study of the processes
involved in pediatric trauma care according to insurance status, looking at
differences in quality of care in real time.

The article, "Lack of Insurance Negatively Affects Trauma Mortality in U.S.
Children," is published in the October issue of the Journal of Pediatric
Surgery.

Children's Hospital Boston is home to the world's largest research enterprise
based at a pediatric medical center, where its discoveries have benefited both
children and adults since 1869. More than 500 scientists, including eight
members of the National Academy of Sciences, 13 members of the Institute of
Medicine and 12 members of the Howard Hughes Medical Institute comprise
Children's research community. Founded as a 20-bed hospital for children,
Children's Hospital Boston today is a 396-bed comprehensive center for
pediatric and adolescent health care grounded in the values of excellence in
patient care and sensitivity to the complex needs and diversity of children
and families. Children's also is the primary pediatric teaching affiliate of
Harvard Medical School. For more information about the hospital and its
research visit: www.childrenshospital.org/newsroom.

CONTACT:
Keri Stedman, Children's Hospital Boston, 617-919-3110,
keri.stedman@childrens.harvard.edu

SOURCE Children's Hospital Boston

Keri Stedman, Children's Hospital Boston, +1-617-919-3110,
keri.stedman@childrens.harvard.edu