Proliferation Of Trauma Centers Lowers Quality, Raises Cost Of Health Care

Driven by the allure of profits and buoyed by an easily marketable emergency medical service, the number of American trauma centers has exploded by 200 additional facilities spread across 20 states in the last three years.

But according to a report by Kaiser Health News and USA Today, these facilities are an overall bad deal for consumers and a drag on the larger health care market. Despite their life-saving potential, trauma centers encourage harmful competition between health professionals and drive up the cost of medical care due to unavoidably high staffing, technological, and medical costs:

The highest-level centers (known as level 1 and level 2) have specially trained staff and surgeons either on call, or at the hospital 24 hours a day. [...] Lower-level trauma centers (known as level 3, 4 or 5), which account for most of the new centers, typically stabilize a patient and arrange for their transfer to a higher-level unit. [...]

When trauma centers operate too close to one another, they compete for specialists and have fewer patients to recoup high fixed expenses for staffing and technology, said Ellen MacKenzie, chairwoman of health policy at Johns Hopkins Bloomberg School of Public Health, who co-authored the New England Journal study.

That can end up costing consumers because hospitals bill insurers to cover their expenses, and insurers pass those on in the form of higher premiums, deductibles and co-pays.

The trend towards high concentrations of lower-level trauma centers presents a double-edged sword for consumers. Although stabilization and transfer facilities can save lives — particularly in rural and isolated regions — they still face exorbitant business costs, and the over-crowding effect not only drives up medical costs and premiums but also lowers the quality of patient care. “The more patients trauma surgeons take care of, the better they do in terms of treatment,” MacKenzie said. “But with too many trauma centers, you dilute that effect.”

Further complicating the matter is the reality that trauma center patients are typically victims of violent crime in inner-cities — the type of patients most likely to be poor or unemployed and least likely to have access to health insurance.

The most feasible method of mitigating the negative consequences of excess trauma facilities is better coordination between regional centers and hospitals that provide broader health services, though such a goal is difficult in the context of for-profit medical competition. Adding consumers to insurance rolls also holds promise for keeping down overall costs as well as providing patients with access to affordable care and post-treatment rehabilitative services. Medicaid already has a strong record of covering such services for consumers, and since many trauma center patients are poor or uninsured, Obamacare’s Medicaid expansion will prove an essential asset for victims of traumatic injuries.