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Table 2. Trends in Trauma Severity, Deaths, and Charges1999 2000 2003Trauma Severity 3 # (%) # (%) # (%)Trauma ISS < =15 64,712 (87.1) 66,635 (86.9) 75,751(87.9)Major Trauma ISS >15 6,480 (8.7) 6,740 (8.8) 7,157(8.3)Unknown or Non-injury 3,083 (4.2) 3,267 (4.3) 3,295 (3.8)Discharge StatusDischarged to home or 53,499 (72.0) 55,629 (72.6) 61,281 (71.1)self-careDischarged to other 19,089 (25.7) 19, 175 (25.0) 22,912 (26.6)FacilityDeceased 1,687 (2.3) 1,838 (2.4) 2,010 (2.3)Source: Texas Health Care Information Council, Hospital Discharge Survey 24IV.Current Issues and ChallengesUncompensated CareTrauma centers are financially vulnerable because in their role of providing critical careservices to a community they treat a disproportionate share of uninsured and underinsuredpatients. There has not been an on-going effort to measure the amount of trauma care coststhat are uncompensated in Texas’ EMS and trauma care systems. However, uncompensatedtrauma hospital costs can be extrapolated from figures supplied by hospitals to the TDSHS tosolicit HB 3588 funds. If these self-reported figures are used, it would appear that Texashospitals spent about $208 million treating uninsured trauma patients in 2003. y This figure isbased on uncompensated trauma care charges to which DSHS applied hospital specific cost-tochargeratios to derive uncompensated trauma care costs for each designated facility. Thefigure is similar to an independent estimate by Bishop+Associates in a 2002 study conducted onbehalf of Save Our ERs in Houston. z Based upon their analysis, 32% of all trauma patients inTexas were uninsured, generating uncompensated costs at these facilities of over $181 million.An effort is being made at the TDSHS to include questions in the annual survey of hospitalsrelated to the provision of care to uninsured emergency and trauma patients. This will likely beincluded in the 2005 Annual Survey which will be administered in mid-2006.Hospitals must recoup their costs, or risk going out of business. The standard practice isto shift the cost of uncompensated care to those who can pay. A recent national studyestimated that in 2005, premium costs for family health insurance coverage provided by privateemployers will include $922 in premiums due to the cost of care for the uninsured. aa Healthinsurance premiums for Texas families is estimated to be $1,551 higher due to theunreimbursed cost of health care for the uninsured. The portion of these costs attributable touncompensated costs of trauma care is unknown.3 Injury severity scores are translated from ICD-9 diagnosis codes using the program developed by Mackenzie.G-8