Rural trauma center closures
High costs, underfunding causes some remote facilities to shutter their doors
The increasing number of hospital trauma center closures in the U.S has had a disproportionate negative effect on high-poverty and rural communities, according to a recent study published in Health Affairs.
The study was conducted and written by Renee Yuen-Jan Hsia of San Francisco General Hospital and Yu-Chu Shen of Naval Postgraduate School, who combined research and data from the AHA Annual Surveys and the 2000 U.S. census to find that by 2007, 69 million Americans had to travel farther to the nearest trauma center than they did in 2001. Almost 16 million people had to travel an additional 30 minutes or more.
Many of the facilities are closing due to trends in high costs, underfunding and treating patients who are unable to pay, primarily impacting socioeconomically disadvantaged, racial and ethnic minorities, and rural communities.
Brock Slabach, senior vice president for member services at the National Rural Health Association, said policymakers must decide if these expensive care facilities and emergency services are valuable enough to continue funding.
“Level one trauma centers are very expensive to operate,” said Slabach. “They require lots of overhead, lots of standby time for professionals, especially surgeons, that have to be immediately available to respond to basically the emergency that’s either brought to the hospital or transferred from a remote location.”
According to the study, between 1990 and 1999 11.3 percent of rural hospitals closed while emergency visits to such hospitals rose by more than 20 percent.
“We know that rural populations are typically underinsured or uninsured as the greater proportion of the population, and therefore the risk to the level one trauma center is if they’re going to be receiving a large amount of patients that may not have the means to pay for the care that they receive,” said Slabach.
Hsia, study co-author and an emergency physician at the San Francisco General Hospital trauma center, said that as a result of these closures, trauma care must be regionalized better, with improved communication between rural doctors and trauma centers.
“We are fortunate in the U.S. to have a lot of resources, but the coordination of those resources is very poor,” said Hsia. “There is some provision in the Affordable Care Act that was passed that talks about the importance of coordinating care, but no requests have been made for appropriation of these funds.”
She said air medical transport is important, especially in rural areas, but that it is not a solution by itself. Communication between rural doctors and trauma centers must improve to assure quality decision-making, said Hsia, who mentioned Telemedicine as a possible aid in deciding whether to transfer a patient.
Telemedicine is a cheap technology, she said. “Just putting in a web cam somewhere and having that doctor either be able to turn that camera to the patient or have a relationship with the trauma center. They can make that call together.”
In their study, Hsia and Shen write that they hope to provide an empirical basis for policy makers and healthcare providers to establish appropriate regional strategies to provide efficient and equitable access to life-saving care.
