But across the country, more and more trauma centers and emergency departments are closing. And they're closing in communities that need them the most.
It isn't that there are fewer emergencies. According to the American Hospital Association, from 1991 to 2010, emergency department visits soared from 88.5 million to 127.2 million. That's an increase of nearly 44 percent.
But during this same period, emergency departments closed at a rate of almost 11 percent. We see something similar with trauma centers. Between 1990 and
2005, 339 trauma centers shut their doors. If we know these services work for terror
attacks as well as ordinary traumas, such as car crashes, then why are they
Over the past four years, Renee Hsia, an emergency medicine physician, and Yu-Chu Shen, an economist, have written about closing emergency rooms and trauma centers.
They have been interested in two primary questions. First, they have tried to figure out what makes a trauma center more likely to close. It turns out a major
reason isn't poor performance. It's cost. Trauma centers are expensive to run; they depend on
public funding (such as Medicare reimbursements) and face financial pressures from HMOs to specialize in more profitable services.
Hsia and Shen have also asked how these closures impact vulnerable populations. Part of the reason that trauma centers are unprofitable is that they
treat many uninsured, or self-pay, patients, and patients on Medicaid. According to the most recent National Trauma Data Bank report, 27 percent of trauma patients are self-pay or Medicaid patients. When
trauma centers close, does it hurt these patients the most?
The answer is yes. To get there, Hsia and Shen studied how driving time to trauma
centers changed over a six year period for 99 percent of the US population, or 283 million people. Here's how they did it. First, they pulled data on
trauma centers from the American Hospital Association annual surveys between 2001 and 2007. Then, they linked this data with demographic data from the 2000
Census. To understand county-level insurance information, they drew from the federal government's 2005 Area Resource Files. Compared with travel times six
years earlier, Hsia and Shen found that one out of every four people had to travel longer to get to a trauma center. And nearly 16 million had to travel at
least thirty minutes more.
Here's where it gets worse. The more vulnerable the population, the farther they had to drive to a trauma center. This means communities with higher shares
of African American residents, uninsured residents, and residents living under the federal poverty level. Rural communities, which we know suffer poor
access to trauma centers, also experienced a significant increase in driving time. These are communities that, already, suffer from health care