Who will cover the cost of undocumented immigrant trauma care?

J Trauma Acute Care Surg. 2012 Mar;72(3):609-12; discussion 612-3. doi: 10.1097/TA.0b013e31824765de.


Background: Health care reform under the "Patient Protection and Affordable Care Act" (PPACA) will lead to changes in reimbursement. Although this legislation provides a mechanism for uninsured Americans to obtain coverage, it excludes undocumented immigrants (UDI). Reimbursement for UDIs comes from the disproportionate share hospital (DSH) program and was previously supported by Section-1011 of the 2003 Medicare Modernization Act (S1011). The PPACA details a cut of DSH funds starting in 2014. This could impose a significant financial burden on trauma centers.

Methods: From May 2005 to May 2008, we retrospectively reviewed all trauma-related emergency room visits by UDIs. We quantified charges for three entities: emergency department physicians, trauma surgeons, and the hospital. We applied our average institutional collection rate to these charges and compared these projected collections with the actual collections.

Results: Over a three-year period, we identified 1,325 trauma UDIs. The financial records revealed a projected emergency department physicians collection of $452,686, a projected trauma surgeons collection of $1.2 million, and a projected hospital collection of $6.9 million (total $8.6 million). Actual funding from S1011 provided $1.7 million and DSH provided $1.9 million (total $3.6 million). Texas State Funding and UDI self-payment contributed $611,082. Overall, our institution had a reimbursement discrepancy of $4.3 million with DSH/S1011 assistance. This increased to $6.0 million after the termination of S1011 and may increase to $7.9 million under PPACA.

Conclusion: These figures underestimate the total cost of UDI trauma care as it only includes three entities. Our data represent a fraction of national figures. Failure to address these issues could result in ongoing financial problems for trauma centers.

Level of evidence: II, economic and decision analysis.

Publication types

  • Comparative Study

MeSH terms

  • Emigrants and Immigrants*
  • Hospital Charges*
  • Hospital Costs
  • Hospitals, Urban / economics
  • Humans
  • Insurance, Health, Reimbursement / economics*
  • Medical Records*
  • Patient Protection and Affordable Care Act / economics*
  • Retrospective Studies
  • Texas / epidemiology
  • Trauma Centers / economics*
  • Wounds and Injuries / economics
  • Wounds and Injuries / ethnology
  • Wounds and Injuries / therapy*