Filling gaps or filling wallets? The role of for-profit medicine in the US trauma system.
cross_sectional · Level IV
Where this comes from
- Record sourced from PubMed, PMID 42018709.
- Also identified by DOI 10.1097/TA.0000000000005018.
- No licence information is recorded for this record.
- Because redistribution is not established, this page shows the abstract only. Follow the links below for the full text.
Abstract
After the US trauma system contracted in the 1990s with the loss of financially vulnerable trauma centers (TCs), a subsequent re-expansion took place. Many new trauma centers are for-profit (FPTCs) and may provide redundant care for affluent populations. Little is known about their role in the national trauma system. We hypothesized that FPTC catchments would provide redundant coverage to affluent populations. Data for the contiguous United States were obtained from the 2020 Decennial Census or American Community Survey. Population-weighted centroids of each census tract, as well as TC locations, were geocoded in ArcGIS Pro. FPTC status was obtained from the Centers for Medicare and Medicaid Services. Road and traffic data were obtained from Esri StreetMaps Premium. The shortest travel time from each population-weighted centroid was calculated to the nearest TC to delineate coverage areas and populations. This analysis was repeated without FPTCs to assess contributions to the trauma system. Data were exported to Stata for further analysis. In total, 83,713 population-weighted centroids and 2,044 TCs were captured. About 11% of tracts were primarily served by 223 FPTCs, representing the closest TC for 43M people. While overall transport times were similar between FPTCs and NPTCs (14.0 vs. 14.2 min, p=ns), the removal of FPTCs did not change national transport times (median 0 min; IQR, 0, 0; range, 0-98). FPTC catchment populations were associated with more urban [odds ratio (OR), 1.02, 95% CI, 1.01-1.02, p<0.001], Hispanic (OR, 1.14, 95% CI, 1.14-1.15, p<0.001), uninsured (OR, 1.65, 95% CI, 1.57-1.73, p<0.001) or Medicare covered (OR, 1.04, 95% CI, 1.02-1.07, p<0.001) populations. Most FPTCs provide redundant care to populations that are often less insured, of similar poverty levels and of different demographics as compared with nonprofit centers. However, a small subset of FPTCs provides access to care for populations who would face long transport times without them.(J Trauma Acute Care Surg. 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). Epidemiological; Level III.