OUTCOME AND COST OF TRAUMA AMONG THE ELDERLY - A REAL-LIFE MODEL OF ASINGLE-PAYER REIMBURSEMENT SYSTEM

Background: As our population ages, the number of elderly trauma patie nts (age greater than or equal to 65 years) increases. Studies have de monstrated increased mortality and cost for a given injury severity in the elderly compared with younger patients. The financial viability o f trauma centers in the United States has been an area of concern for many years. As reimbursement diminishes for privately insured patients , the ability to finance the care of the indigent is jeopardized. Medi care, the single-payer insurance plan for the elderly, reimburses at a lower rate than standard private insurance carriers. We examined the differences in outcome and cost between the elderly and younger patien ts and the financial burden imposed by care for elderly trauma. Our hy pothesis was that elderly trauma patients would have poorer outcomes, higher cost, and generate greater financial losses than younger patien ts. Methods: All patients admitted to the University of Virginia Traum a Service from July 1, 1994, to July 1, 1997 were included. Trauma reg istry and patients records were examined. Patients with incomplete fin ancial data (cost, reimbursement, and payer source) were excluded. Pat ients were grouped by age (18-64 and greater than or equal to 65 years ), Injury Severity Score, and payer source. Results: One thousand one hundred twenty-seven patients met the entry criteria. One hundred fort y patients had incomplete financial or patient data and were excluded. Nine hundred eighty-seven patients were included in the study, of whi ch 159 were elderly and 828 were 18 to 64 years of age. Injury Severit y Scores were significantly higher in the elderly group. Only 2% of el derly patients were uninsured (76% were insured by Medicare), whereas 25% of younger patients were uninsured. Medicare reimbursement rates a ctually exceeded those of all other carriers (114% of costs). Elderly patients had a higher mortality rate, but the z score did not reach si gnificance. The W score, however, indicated that there were more unexp ected, negative outcomes among elderly patients, As injury severity in creased, profit per case increased in the elderly and decreased in the younger group. Conclusion: Despite higher injury severity and lower s urvival probability for the elderly, the length of hospital and intens ive care unit stays, as well as the percentage of admissions to the in tensive care unit, were similar. The per capita cost of hospital care for the elderly was lower than for younger patients, whereas reimburse ment was higher, primarily because 98% of elderly patients were insure d. Medicare, the single-payer insurance plan for the elderly, adequate ly reimburses for elderly trauma care. This implies that universal ins urance coverage for all trauma patients would be desirable, even if re imbursement rates decreased significantly. The increased mortality in the elderly requires continued study and diligence.