Affordable trauma care?

Traumatic injuries are devastating in more than one way. The physio- and psychological consequences of major trauma can last a lifetime, depending on the constellation of injuries and organ systems affected. In addition, trauma patients may experience significant financial burdens because of hospital bills, physician fees, lost income, and loss of future insurability. This month’s column looks at how provisions in the Affordable Care Act (ACA) are affecting access to care for Americans as a whole and considers the potential effects on trauma care.

Expanded access to care

In 2010, six months after enactment of the ACA, a Patient’s Bill of Rights went into effect, which prohibits insurance companies from denying health care coverage to children based upon preexisting conditions, eliminates lifetime limits on coverage, regulates annual limits on insurance coverage, and provides an appeal process for insurance company denials. Additional changes include payment relief for senior citizens affected by the Medicare prescription “donut hole,” adds preventive service coverage in new plans, cracks down on health care fraud, and extends coverage for young adults.

In 2012, ACA regulations targeted improving quality and outcomes, and in late 2013 came the much-anticipated increase in access to health care insurance coverage under the ACA. Some glitches occurred in the process of enrolling millions of patients in insurance plans, but the goal of bringing affordable and qualified health plans to individuals and small businesses was largely realized.* In 2008, Gallup and Healthways began tracking the percentage of Americans without health insurance. In that first year, the rate started out at 14.6 percent, and it peaked at 18 percent in mid-2013. When the requirement for most Americans to have health insurance went into effect in the early part of 2014, however, this percentage decreased sharply.

Percent of Self-Pay by Year

Percent of Self-Pay by Year

Self-pay in trauma care

The National Trauma Data Bank® (NTDB®) Annual Report is based upon trauma admission for the preceding year. This year’s Annual Report is based on 2013 admissions. When looking at the most recent five years, which include 2009 through 2013 admission years, the percentage of self-pay patients remained consistent at 15.12, 15.56, 15.10, 14.9, and 14.4, respectively. These percentages are compared by year with the U.S. population of uninsured in the figure on this page.

The 2014 percentage of uninsured Americans is the lowest it has been since tracking began in 2008. It will be interesting to see what happens to the percentage of trauma admissions that are self-pay when reviewing the 2014 admission records to be included in the 2015 Annual Report. Will we see a comparable drop in the self-pay percentage and the start of affordable trauma care?

Throughout the year, we will be highlighting these data through brief reports in the Bulletin. The NTDB Annual Report 2014 is available on the ACS website.

In addition, information about how to obtain NTDB data for more detailed study is posted on the website. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal Manager, NTDB at

*U.S. Department of Health and Human Services. Key Features of the Affordable Care Act by Year. Available at: Accessed December 24, 2014.

Levy J. In U.S., Uninsured rate holds at 13.4%. Gallup. Available at: Published October 8, 2014. Accessed December 24, 2014.


Tagged as: , ,


Bulletin of the American College of Surgeons
633 N. Saint Clair St.
Chicago, IL 60611


Download the Bulletin App

Apple Store
Get it on Google Play
Amazon store