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The federal Emergency Medical Treatment and Active Labor Act requires hospitals to treat trauma patients until they’re medically stable, regardless of insurance status. Yet a retrospective study led by Heather Rosen, MD, MPH, research fellow in Children’s Hospital Boston’s Department of Plastic Surgery, found that uninsured children were 3.3 times more likely to die from trauma-related injuries than children with commercial insurance plans like Blue Cross/Blue Shield. In addition, children insured by public plans like Medicaid or SCHIP were 1.19 times more likely to die from trauma than commercially insured children.
The study, published in the Journal of Pediatric Surgery in October, analyzed data from the National Trauma Data Bank and adjusted for factors such as age, gender, race, injury severity and injury type. Because the study was retrospective, the researchers aren’t sure why the mortality rates differed. They speculate that trauma patients with public or no insurance get fewer diagnostic tests, or are transferred from one hospital to another, delaying proper treatment. Or their families may be less educated or less fluent in English and therefore less able to communicate effectively with medical providers.
“This paper provokes more questions than it answers,” Rosen acknowledges. In the future, she would like to conduct a prospective study, looking at differences in quality of care in real time. Rosen also published a parallel study of 687,000 adults admitted for trauma in the November Archives of Surgery. Similar to the pediatric study, uninsured patients had 1.8 times greater mortality than insured patients.
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