@article{ref1,
title="Trauma-induced insurance instability: variation in insurance coverage for patients who experience readmission after injury",
journal="Journal of trauma and acute care surgery",
year="2018",
author="Rajasingh, Charlotte M. and Weiser, Thomas G. and Knowlton, Lisa M. and Tennakoon, Lakshika and Spain, David A. and Staudenmayer, Kristan L.",
volume="84",
number="6",
pages="876-884",
abstract="INTRODUCTION: Traumatic injuries result in a significant disruption to patients' lives, including their ability to work, which may place patients at risk of losing insurance coverage. Our objective was to evaluate the impact of injury on insurance status. We hypothesized that trauma patients with ongoing health needs experience changes in coverage. <br><br>METHODS: We used the Nationwide Readmission Database (2013-2014), a nationally representative sample of readmissions in the United States. We included patients ages 27-64 admitted with any diagnosis of trauma with at least one readmission within 6 months. Patients on Medicare and with missing payer information were excluded. The primary outcome was payer status. <br><br>RESULTS: 57,281 patients met inclusion criteria, 11,006 (19%) changed insurance payer at readmission. Of these, 21% (n=2,288) became uninsured, 25% (n=2,773) gained coverage, and 54% (n=5,945) switched insurance. Medicaid and Medicare gained the largest fraction of patients (from 16% to 30% and 0% to 18%, respectively), with a decrease in private payer coverage (37% to 17%). In multivariate analysis, patients who were younger (27-35y vs. 56-64y, OR:1.30, p<0.001); lived in a zip code with average income in the lowest quartile (vs. the highest quartile, OR:1.37, p<0.001); and had ≥3 comorbidities (vs. none OR: 1.61, p<0.001) were more likely to experience a change in insurance. <br><br>CONCLUSION: Approximately one fifth of trauma patients who are readmitted within 6 months of their injury experience a change in insurance coverage. Most switch between insurers, but nearly a quarter lose their insurance. The government adopts a large fraction of these patients indicating a growing reliance on government programs like Medicaid. Trauma patients face challenges after injury, and a change in insurance may add to this burden. Future policy and quality improvement initiatives should consider addressing this challenge. LEVEL OF EVIDENCE: Epidemiologic; Level III.<p /> <p>Language: en</p>",
language="en",
issn="2163-0755",
doi="10.1097/TA.0000000000001832",
url="http://dx.doi.org/10.1097/TA.0000000000001832"
}