Financial aspects of providing trauma care at the extremes of life

Background: Children and the elderly are more likely to be underinsured com pared with the general population of trauma patients. We performed financia l analysis on all trauma patients admitted during an 18-month period to a L evel I adult and pediatric trauma center to evaluate the financial impact o f providing trauma care for children and the elderly. Methods: Patients were categorized by age: PEDI < 17 years, GERI > 64 years and MID = 17 to 64 years. Reimbursement ratio (RR = reimbursement/cost; RR > 1 = profit, RR < 1 = loss), length of stay (LOS), and Injury Severity Sc ore (ISS) were calculated for each age group. Results: RR for GERI (RR = 0.99) was significantly lower than for PEDI (RR = 1.15) and MID (RR = 1.16). There was no difference in ISS, but the LOS of GERI was greater than that of PEDI and MLD (p < 0.05). Cost per patient an d LOS were less in PEDI versus MID and GERI (p < 0.05). Conclusion: Trauma care reimbursement for the elderly is inadequate, wherea s pediatric trauma care costs less to deliver and is profitable to the trau ma center.