Online Program

Trauma care and insurance coverage: The relationship between insurance type and diagnostic imaging over the course of care

Tuesday, November 3, 2015 : 4:30 p.m. - 4:45 p.m.

Nathaniel Bell, PhD, College of Nursing, University of South Carolina, Columbia, SC
Laura Reparaz, MSc, Nursing, University of South Carolina, Columbia, SC
R. Stephen Smith, MD, Surgery, University of South Carolina, Columbia, SC
William Fry, MD, RVT, RDMS, Surgery, University of South Carolina, Columbia, SC

Uninsured patients are known to receive fewer radiographic studies during trauma care. Our objective was to determine whether these differences are exhibited across multiple insurance types and across different periods of care.


Patient data were obtained from an ACS Verified Level I Trauma Center between January 1, 2011 and December 31, 2012. A total of 3,621 records from surviving patients age ≥18 years were assessed. Multiple logistic regression models were used to compare the type and frequency of radiographic imaging received by insurance type, adjusting for age, sex, race/ethnicity, injury severity score, injury mechanism, comorbidities, complications, hospital length of stay, and ICU admission.


Adjusted analysis showed lower odds of screening for Medicare (0.85, 95% CI 0.78 – 0.93), Medicaid (0.89, 0.81 – 0.99), the uninsured (0.90, 0.85 – 0.96), and government insurance (0.81, 0.72 – 0.90) compared to patients with private insurance for total hospital stay. Variations in imaging by insurance type during the first 24-hours were only found among those on Medicare (0.78, 0.71 – 0.86) and Government (0.83, 0.74 – 0.94) insurance types.


These results demonstrate that insurance type is a determining factor for receipt of diagnostic imaging during an entire episode of care, but there is limited evidence to suggest that factors other than patient pathology determine which interventions are delivered during the first 24-hours. Evaluating variation in trauma care during acute and overall periods of care may be a preferable approach for identifying when discretionary care occurs.

Learning Areas:

Clinical medicine applied in public health
Other professions or practice related to public health
Provision of health care to the public
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Demonstrate the value of using multiple time points for evaluating the role of insurance status as a determinant of trauma care.

Keyword(s): Health Insurance, Treatment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have over seven years experience researching disparities in outcomes of trauma care. A primary objective of my doctoral thesis was an investigation into disparities in trauma care that could be attributed to socioeconomic and geographic factors. Since this time, I have also served as a co-investigator on federally funded research investigations (Canada) focusing on outcome indicators for evaluating the quality of trauma care.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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