Js. Young et al., OUTCOME AND COST OF TRAUMA AMONG THE ELDERLY - A REAL-LIFE MODEL OF ASINGLE-PAYER REIMBURSEMENT SYSTEM, The journal of trauma, injury, infection, and critical care, 45(4), 1998, pp. 800-804
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.