“…This finding, although disconcerting, is consistent with studies revealing that physicians are often reluctant to accept or provide care to patients with insurance plans providing lower reimbursement. 28 -31 Moreover, injured children tend to have higher reimbursement rates compared with injured adults, 32,33 which may also be driving differences specific to each population in relation to insurance status. In addition, given that most trauma centers are publicly owned and located in metropolitan areas, it might also be possible that injured pediatric patients and their families with private insurance in nontrauma centers located in the nonmetropolitan area are less willing to be transferred, sometimes longer distances, to a designated trauma center.…”