Critically injured? Maybe it’s better not to have health insurance

Common sense tells you that having health insurance should improve your health. But in the emergency room, having insurance might actually put you at a disadvantage.

According to a new analysis by University of Pennsylvania Emergency Medicine physician Kit Delgado, being insured makes you 11 to 14 percent more likely to be admitted to a hospital after an ER visit instead of being transferred to a trauma center.

For Delgado, that’s troubling. “We know that, if patients have life-threatening injuries, that being treated in a specialized trauma center reduces your risk of dying by at least 25 percent,” he said.

Published in the journal JAMA Surgery, the analysis found that rural hospitals unequipped for critical cases almost always transfer — regardless of insurance status. But with hospitalizations costing $50,000 to $80,000, it looks like reimbursement begins to factor in, especially for larger, urban teaching hospitals.

“If you have some type of health insurance coverage, and the hospital that you present to has some specialists that can care for your condition,” Delgado said, “they are more willing to admit you there. If you have no insurance coverage, that might tip the scales for that patient to be transferred.”

Delgado said he wants to check that it’s not just that insured patients are more likely to ask to skip the transfer, which in many areas of the country might mean going far from home.

“If they don’t have a preference, then it would suggest financial motivations are complicating the right decision for where these patients should get treated,” he said, “and that we need incentives to counteract those motivations so that we can improve the total health of the population.”

One idea, Delgado said, is to split the reimbursement between the transferring and receiving hospitals.