A growing number of hospitals are shutting down expensive trauma centers, a trend that is leaving many African Americans, low-income individuals and residents in rural areas without convenient access to potentially life-saving crisis care, according to a new study released this month.
The study, which appears in the October issue of Health Affairs magazine, was conducted by Renee Yuen-Jan Hsia at San Francisco General Hospital and Yu-Chu Shen of Naval Postgraduate School in Monterey, Calif.
The authors surveyed 31,475 ZIP codes covering 283 million people – about 99 percent of the U.S. population – and found that 69 million Americans had to travel farther in order to get to the nearest trauma center in 2007 compared to 2001. Not only that, but nearly 16 million people in 2007 had to travel 30 minutes or more to their nearest trauma center.
Over the past decade, trauma centers have been closing at an accelerated rate. In 1990, there were 1,125 trauma centers across the United States. By 2005, 339 of those had closed. This compares to only 66 closures between 1981 and 1991. Several factors have been at play over the past 10 years that have caused more of these facilities to shut down – the cost of trauma care has sharply risen; more centers began treating patients who were unable to pay for care; Medicare has scaled back payments; and the rapid growth of managed care in the 1990s resulted in lower negotiated payments.
There are no federal or state requirements that dictate the number of trauma centers for any given community, so the decision to close a hospital’s trauma center is largely driven by market factors and the hospital’s mission, the report explains. Some trauma center closures may also be the result of increasing consolidation of healthcare systems.
Overall, nearly three-quarters of the U.S. population resides within 10 miles of a trauma center. At the other extreme, 14 percent of Americans live more than 30 miles from a facility that provides trauma care.
While a majority of Americans have convenient access to trauma care, the report shows that poor and African American communities and rural residents are disproportionately affected by deteriorating access to crisis care.
From 2001 to 2007, most of the trauma center closures occurred in urban areas because more centers are typically located in urban areas. But rural areas have also been affected by closures. In urban regions, 71 percent of individuals living in those areas are within 10 miles of the nearest trauma center while only 24 percent of people living in rural areas have trauma centers within 10 miles.
The access problem, which can leave people dying or disabled, was also much worse in high-poverty zip codes. Communities with a greater percentage of residents under the federal poverty level were at a higher risk of having at least a 30-minute increase in driving time to a trauma center in both urban and rural areas.
Communities and ZIP codes with a high percentage of African Americans also faced a higher risk of having a drive time of 30 minutes or more to the nearest trauma center compared with areas with low proportions of African American residents.
“We do not attempt to draw casual relationships; rather, we wish to substantiate concerns about increased trauma center closures in vulnerable communities and to alert policy makers about them,” the authors say in the study.
They point out that disparities in health indicators such as mortality from traumatic injuries have worsened for African Americans, Hispanic and low-income groups.
“Deteriorating access to emergency care, such as that available in trauma centers, could create systemic disparities of care for vulnerable patients,” the report says.
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