Effect of the COVID-19 pandemic on health insurance coverage among trauma patients: a study of six level I trauma centers

Abstract

BackgroundIncreased unemployment during the COVID-19 pandemic has likely led to widespread loss of employer-provided health insurance. This study examined trends in health insurance coverage among trauma patients during the COVID-19 pandemic, including differences in demographics and clinical characteristics by insurance type.MethodsThis was a retrospective study on adult patients admitted to six level 1 trauma centers between January 1, 2018 and June 30, 2020. The primary exposure was hospital admission date: January 1, 2018 to December 31, 2018 (Period 1), January 1, 2019 to March 15, 2020 (Period 2), and March 16, 2020 to June 30, 2020 (Period 3). Covariates included demographic and clinical variables. χ² tests examined whether the rates of patients covered by each insurance type differed between the pandemic and earlier periods. Mann-Whiney U and χ² tests investigated whether patient demographics or clinical characteristics differed within each insurance type across the study periods.ResultsA total of 31 225 trauma patients admitted between January 1, 2018 and June 30, 2019 were included. Forty-one per cent (n=12 651) were admitted in Period 1, 49% (n=15 258) were from Period 2, and 11% (n=3288) were from Period 3. Percentages of uninsured patients increased significantly across the three periods (Periods 1 to 3: 15%, 16%, 21%) (ptrend=0.02); however, there was no accompanying decrease in the percentages of commercial/privately insured patients (Periods 1 to 3: 40%, 39%, 39%) (ptrend=0.27). There was a significant decrease in the percentage of patients on Medicare during the pandemic period (Periods 1 to 3: 39%, 39%, 34%) (p<0.01).DiscussionThis study found that job loss during the COVID-19 pandemic resulted in increases of uninsured trauma patients. However, there was not a corresponding decrease in commercial/privately insured patients, as may have been expected; rather, a decrease in Medicare patients was observed. These findings may be attributable to a growing workforce during the study period, in combination with a younger overall patient population during the pandemic.Level of evidenceRetrospective, level III study.

Trauma Prevalence and Resource Utilization During 4 COVID-19 “Surges”: A National Analysis of Trauma Patients From 92 Trauma Centers

“…But in subsequent surges (3, 4), all groups except those who were privately insured increased with the largest increase occurring in the Medicaid group. Our results showed Medicaid patients increased and privately insured patients decreased during the pandemic period, whereas Sercy et al 3 reported opposite trends in Medicaid and privately insured patients during the pandemic period. 3 However, Sercy et al 3 only analyzed 6 Level 1 TCs which may limit the generalizability of their results.…”

“…Our results showed Medicaid patients increased and privately insured patients decreased during the pandemic period, whereas Sercy et al 3 reported opposite trends in Medicaid and privately insured patients during the pandemic period. 3 However, Sercy et al 3 only analyzed 6 Level 1 TCs which may limit the generalizability of their results. Moreover, the increase in Medicaid patients is consistent with a report from the Department of Health and Human Services (DHHS) that revealed significantly more patients enrolled in Marketplace or Medicaid coverage.…”

“…1 , 2 As a result, unemployment rose and increasingly higher rates of uninsured patients began presenting to trauma centers (TCs) during the pandemic. 3 ED visits dwindled during the first surge and elective surgeries were cancelled, inflicting substantial financial strain on the healthcare system. 4 , 5 Individuals spent progressively more time indoors, reducing motor vehicle collisions (MVCs), and cases of interpersonal violence became increasingly more common.…”

Impact of the first COVID-19 shutdown on traumatological patient volumes in Switzerland

“…Sercy et al [34] showed a clear trend of increasing rates of uninsured patients during the pandemic. However, the rates of individuals covered by private insurance did not decline during the pandemic.…”

Racial Differences and Injury Pattern Variation: Impact of COVID-19 on a Bronx Trauma Center

“…Considering these anecdotal experiences and that COVID-19 had a marked effect on daily activities, unemployment level, and well-being, 6 – 8 the objective of this study was to assess temporal effects of the pandemic on trauma volume, demographics, and mechanism of injury patterns. Trauma patients admitted to our trauma center before, during, and immediately after the first wave of COVID-19 in NYC were analyzed.…”