Level I trauma centers often exist within Safety-Net Hospitals (SNHs), facilities servicing high proportions of low-income and uninsured patients. Given the current healthcare funding environment, trauma centers within SNHs may be at particular risk. Using California as a model, we hypothesized that SNHs with trauma centers vary in terms of financial stability.
A retrospective cohort study using data from publically-available financial disclosure reports from California's Office of Statewide Health Planning and Development. Safety-net hospitals were identified from the California Association of Public Hospitals and Health Systems. The primary outcome metric for financial performance was operating margin.
California hospitals with Level I Trauma Centers were analyzed (11 SNH sites, 2 non SNH). SNHs did not behave uniformly, and were clustered into county owned SNHs (36%, n=4) and non-profit owned SNHs (64%, n=7). Mean operating margins for county SNHs, non-profit SNHs and non SNHs were -16.5%, 8.4% and 9.5% respectively (p<0.001). From 2010 to 2015, operating margins improved for all hospitals, partly due to increases in the percent of insured patients and changes in payer mix. Non-profit SNHs had a payer mix similar to non SNHs, whereas county SNHs had the highest proportions of MediCal (California Medicaid) (45% vs. 36% vs. 12%, p<0.001) and uninsured patients (17% vs. 5% vs. 0%, p<0.001) compared to non-profit SNHs and non SNHs respectively.
The majority (85%) of Level I Trauma Centers are within SNHs, whose financial stability is highly variable. A group of SNHs rely upon on infusions of government funds and are therefore susceptible to changes in policy. These findings suggest deliberate funding efforts are critical to protect the health of the U.S. academic trauma system.