Figure 6.1 Reimbursement profile for all service areas. Source: Eastman et al. (1994). Reprinted with permission from Lippincott, Williams and Wilkins.

The cost-recovery profile presented in Figure 6.1, although limited to a sample of trauma centers surveyed in 1992, illustrates the general principle that the most generous rates of recovery for patient care costs are from fee-for-service health insurance, auto insurance, and workers' compensation. This profile, however, fails to capture the great degree of expansion of managed care into the private and public sectors (see following section). As managed care continues to infiltrate the health care market, the ability of trauma centers and hospitals to shift costs from publicly to privately insured patients is jeopardized. This trend is likely to present new challenges in trauma care financing, the viability of trauma centers, and the quality of patient care in the future.

The increasing cost of patient care provides financial incentives for payers such as employers and health insurers to embrace injury prevention, both in occupational and in nonoccupational settings. Prevention programs have the potential to reduce health care costs. With an effective prevention program, reductions in health care costs may even be experienced in the short term (i.e., while the enrollee is still covered), compared to prevention programs for chronic conditions, such as heart disease, where cost reductions are more likely to be experienced in the long term (i.e., after enrollment has lapsed). The immediacy of prevention payoffs for injuries is likely an important consideration for payers. Payers should be eager to support injury prevention programs with their potential for short-term results because enrollee turnover tends to be high.