American Trauma Care: A System of Systems

Johnson, Robert L.; Larson, Nicholas J.; Brown, Catherine Ting; Iyegha, Uroghupatei P.; Blondeau, Benoit; Dries, David J.; Rogers, Frederick B.

doi:10.1016/j.amj.2023.07.002

Cited by 6 publications

(2 citation statements)

References 41 publications

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“… 15 Additional promises also remain to be upheld: the US$224 million allotment to trauma care and research by the ACA has yet to be distributed, and a subsequent effort in 2015 to pass the Trauma Systems and Regionalization of Emergency Care Reauthorization Act, which would allocate money from the Public Health Service Act, remains introduced but unvoted on by the Senate. 16 The implementation of the ACA has also resulted in a significant decrease in other sources of trauma center funding. One study reported a shift in the payor mix, leading to fewer commercially insured patients, which has been an essential avenue for maintaining trauma center margins.…”

Section: Costsmentioning

confidence: 99%

Trauma centers: an underfunded but essential asset to the community

Fracasso,

Ahmed

2024

Trauma Surg Acute Care Open

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Research indicates that specialized trauma centers, especially those of level I and II designation, can generate revenue if financial support is provided, and most importantly provide better outcomes for an injured patient by reducing length of stay and mortality when compared with treatment at hospitals without trauma center designation.Costs associated with trauma center operation have risen over the past few years in association with growing patient volumes and inflation. Documentation regarding costs for trauma center operations is sparse, and there exists a large variance between reported numbers based on their region. In most cases, the greatest proportion of funds are spent on clinical personnel while the smallest fraction is dedicated to educational and prevention programs. Studies confirm that as a product of these rising costs and a lack of state and federal funding that trauma centers remain uniquely financially vulnerable.Multiple strategies have been implemented to mitigate these costs but have proven insufficient. Legislations providing patients with expanded access to healthcare such as the Affordable Healthcare Act have failed to deliver on their intended purposes, and managed care organizations have moved to protect their own interest at the expense of trauma patient mortality. In lieu of concerted federal support, states and municipalities have explored solutions to support trauma centers such as small fees added to fines or encouraging charitable donations, although these programs have not seen ubiquitous implementation. Most trauma centers have begun incorporating activation costs to recoup losses from their low reimbursement rate, but these have continued to inflate, and pose a growing burden on vulnerable patients.Lack of funding from external sources such as state or federal appropriations poses a tangible threat to trauma centers for closure, and with multiple trauma centers acting as critical pillars of healthcare infrastructure for disadvantaged communities as well as the impact of this lack of funding being so broad and systemic, multiple ‘trauma deserts’ may emerge, leaving communities—especially disadvantaged communities which rely on the safety-net function of many high designation trauma centers—deprived of an essential treatment resource and increasing annual mortalities that could have otherwise been averted.

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Section: Costsmentioning

confidence: 99%

Trauma centers: an underfunded but essential asset to the community

Fracasso,

Ahmed

2024

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

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“…7 Even the richest nations show heterogeneity in their approach to trauma systems, both between and within countries. 8,9 LMIC health systems, frequently embedded in fragile or uncertain governmental structures, are confronted with a number of obstacles to improvement. Co-ordination both within and between healthcare institutions can present a significant challenge in resource-limited settings, who also face the greatest need.…”

Section: Trauma Systems In Resource-poor Countriesmentioning

confidence: 99%