Recent study published in the Archives of Surgery indicates that uninsured patients have an 80% higher chance of dying from trauma. This is shocking. Is it surprising? Yes, I would say it is. There could be some methodological issues with the study, but I am not going to dispute the results. Assuming this is true, why would the patients with no insurance have a much higher mortality from trauma? I am involved in caring for the trauma patients and we do not base our treatment decisions based on the insurance status. Regardless of the insurance, the patients get the studies, surgical procedures and medical treatment they need. We do not discharge patients earlier just because there is no insurance. The follow-up care maybe is different for the uninsured. I cannot imagine, though, that this would affect the mortality so much.

What about the pre-Hospital treatment? We know that paramedics do not ask for insurance. ER could not refuse the patient as well. Once evaluated in ER, the patient would be admitted to a Trauma Center. I have never heard of somebody being refused an admission to a Trauma Center for the lack of insurance (assuming the patient needs admission for medical reasons). Maybe I just live in an ‘ideal world’.

I wonder if there is a difference in the preexisting conditions between insured and uninsured. If the patient has poorly controlled diabetes, hypertension or coronary artery disease that would, definitively, affect the mortality. This brings us to a healthcare reform debate and we are not going to go there yet.

Also, I wonder if there is a difference in the severity of trauma between two groups of patients. The study should adjust for it, though. It would be interesting to see if there was a difference in the average alcohol level between those patients as well. Just from my personal experience – a lot of people who decide to drive while drunk are not very concerned about having medical insurance either. Though, this is just an observation.