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Effect of the COVID-19 pandemic on health insurance coverage among trauma patients: a study of six level I trauma centers

BACKGROUND: Increased unemployment during the COVID-19 pandemic has likely led to widespread loss of employer-provided health insurance. This study examined trends in health insurance coverage among trauma patients during the COVID-19 pandemic, including differences in demographics and clinical char...

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Autores principales: Sercy, Erica, Duane, Therese M, Lieser, Mark, Madayag, Robert M, Berg, Gina, Banton, Kaysie L, Hamilton, David, Bar-Or, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023754/
https://www.ncbi.nlm.nih.gov/pubmed/33884306
http://dx.doi.org/10.1136/tsaco-2020-000640
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author Sercy, Erica
Duane, Therese M
Lieser, Mark
Madayag, Robert M
Berg, Gina
Banton, Kaysie L
Hamilton, David
Bar-Or, David
author_facet Sercy, Erica
Duane, Therese M
Lieser, Mark
Madayag, Robert M
Berg, Gina
Banton, Kaysie L
Hamilton, David
Bar-Or, David
author_sort Sercy, Erica
collection PubMed
description BACKGROUND: Increased unemployment during the COVID-19 pandemic has likely led to widespread loss of employer-provided health insurance. This study examined trends in health insurance coverage among trauma patients during the COVID-19 pandemic, including differences in demographics and clinical characteristics by insurance type. METHODS: This was a retrospective study on adult patients admitted to six level 1 trauma centers between January 1, 2018 and June 30, 2020. The primary exposure was hospital admission date: January 1, 2018 to December 31, 2018 (Period 1), January 1, 2019 to March 15, 2020 (Period 2), and March 16, 2020 to June 30, 2020 (Period 3). Covariates included demographic and clinical variables. χ² tests examined whether the rates of patients covered by each insurance type differed between the pandemic and earlier periods. Mann-Whiney U and χ² tests investigated whether patient demographics or clinical characteristics differed within each insurance type across the study periods. RESULTS: A total of 31 225 trauma patients admitted between January 1, 2018 and June 30, 2019 were included. Forty-one per cent (n=12 651) were admitted in Period 1, 49% (n=15 258) were from Period 2, and 11% (n=3288) were from Period 3. Percentages of uninsured patients increased significantly across the three periods (Periods 1 to 3: 15%, 16%, 21%) (p(trend)=0.02); however, there was no accompanying decrease in the percentages of commercial/privately insured patients (Periods 1 to 3: 40%, 39%, 39%) (p(trend)=0.27). There was a significant decrease in the percentage of patients on Medicare during the pandemic period (Periods 1 to 3: 39%, 39%, 34%) (p<0.01). DISCUSSION: This study found that job loss during the COVID-19 pandemic resulted in increases of uninsured trauma patients. However, there was not a corresponding decrease in commercial/privately insured patients, as may have been expected; rather, a decrease in Medicare patients was observed. These findings may be attributable to a growing workforce during the study period, in combination with a younger overall patient population during the pandemic. LEVEL OF EVIDENCE: Retrospective, level III study.
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spelling pubmed-80237542021-04-08 Effect of the COVID-19 pandemic on health insurance coverage among trauma patients: a study of six level I trauma centers Sercy, Erica Duane, Therese M Lieser, Mark Madayag, Robert M Berg, Gina Banton, Kaysie L Hamilton, David Bar-Or, David Trauma Surg Acute Care Open Original Research BACKGROUND: Increased unemployment during the COVID-19 pandemic has likely led to widespread loss of employer-provided health insurance. This study examined trends in health insurance coverage among trauma patients during the COVID-19 pandemic, including differences in demographics and clinical characteristics by insurance type. METHODS: This was a retrospective study on adult patients admitted to six level 1 trauma centers between January 1, 2018 and June 30, 2020. The primary exposure was hospital admission date: January 1, 2018 to December 31, 2018 (Period 1), January 1, 2019 to March 15, 2020 (Period 2), and March 16, 2020 to June 30, 2020 (Period 3). Covariates included demographic and clinical variables. χ² tests examined whether the rates of patients covered by each insurance type differed between the pandemic and earlier periods. Mann-Whiney U and χ² tests investigated whether patient demographics or clinical characteristics differed within each insurance type across the study periods. RESULTS: A total of 31 225 trauma patients admitted between January 1, 2018 and June 30, 2019 were included. Forty-one per cent (n=12 651) were admitted in Period 1, 49% (n=15 258) were from Period 2, and 11% (n=3288) were from Period 3. Percentages of uninsured patients increased significantly across the three periods (Periods 1 to 3: 15%, 16%, 21%) (p(trend)=0.02); however, there was no accompanying decrease in the percentages of commercial/privately insured patients (Periods 1 to 3: 40%, 39%, 39%) (p(trend)=0.27). There was a significant decrease in the percentage of patients on Medicare during the pandemic period (Periods 1 to 3: 39%, 39%, 34%) (p<0.01). DISCUSSION: This study found that job loss during the COVID-19 pandemic resulted in increases of uninsured trauma patients. However, there was not a corresponding decrease in commercial/privately insured patients, as may have been expected; rather, a decrease in Medicare patients was observed. These findings may be attributable to a growing workforce during the study period, in combination with a younger overall patient population during the pandemic. LEVEL OF EVIDENCE: Retrospective, level III study. BMJ Publishing Group 2021-04-02 /pmc/articles/PMC8023754/ /pubmed/33884306 http://dx.doi.org/10.1136/tsaco-2020-000640 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Original Research
Sercy, Erica
Duane, Therese M
Lieser, Mark
Madayag, Robert M
Berg, Gina
Banton, Kaysie L
Hamilton, David
Bar-Or, David
Effect of the COVID-19 pandemic on health insurance coverage among trauma patients: a study of six level I trauma centers
title Effect of the COVID-19 pandemic on health insurance coverage among trauma patients: a study of six level I trauma centers
title_full Effect of the COVID-19 pandemic on health insurance coverage among trauma patients: a study of six level I trauma centers
title_fullStr Effect of the COVID-19 pandemic on health insurance coverage among trauma patients: a study of six level I trauma centers
title_full_unstemmed Effect of the COVID-19 pandemic on health insurance coverage among trauma patients: a study of six level I trauma centers
title_short Effect of the COVID-19 pandemic on health insurance coverage among trauma patients: a study of six level I trauma centers
title_sort effect of the covid-19 pandemic on health insurance coverage among trauma patients: a study of six level i trauma centers
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023754/
https://www.ncbi.nlm.nih.gov/pubmed/33884306
http://dx.doi.org/10.1136/tsaco-2020-000640
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