Thursday Roundup: Disappearing Trauma Care

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Hundreds of trauma centers have closed over the past two decades and, as a result, millions of Americans are finding they are now farther away from hospitals equipped to handle the most complex injuries. 

A study in the journal Health Affairs found that the distance to a trauma center increased for 69 million people between 2001 and 2007. The median increase in travel time was 10 minutes. But for 16 million people, travel times to a trauma center increased by 30 minutes or longer. 

“The greatest impact from diminished access has been on people in rural communities and in areas with high shares of African-American residents, low-income people and uninsured. The trend exacerbates disparities in health care,” according to an AP report on the study, which is gated.

The study found that most trauma centers that closed did so for financial reasons. They treated too many people who lacked insurance.

The Obama administration has recommended cuts in a premium paid to rural critical access hospitals. The administration’s recommendations would cut Medicare reimbursements by $6 billion over ten years.

In 1990, there were 1,125 trauma centers in the U.S. Over the next 15 years, 339 had closed.

Medical experts agree that victims of trauma stand the best chance of surviving if they are treated within an hour. Only a quarter of rural residents now live within ten miles of a trauma center.

“We’re not saying that we should build a trauma center on every street corner. That would not be cost-effective,” said Dr. Renee Hsia, lead researcher on the report. “But we do have evidence that access for certain populations is already pretty bad, and it’s getting worse.”

• Meanwhile, fewer jobs are coming with health insurance. The Iowa Policy Project finds that 40 percent of the U.S. workforce in 2009 was in a job that wasn’t full time or didn’t provide health insurance. Four years earlier, that number was 27 percent. 

It doesn’t take too much to connect the dots: rural hospitals are closing because they are treating too many uninsured patients. And more people are working jobs that don’t have health insurance.

• One of the heroes of the American civil rights movement and a child of rural America, the Rev. Fred L. Shuttlesworth, died Wednesday in Birmingham, Alabama.

Shuttlesworth was born 89 years ago in Mount Meigs, Alabama. He was a the son of sharecroppers and worked as a truck driver before being called to the pulpit. Where Dr. Martin Luther King’s style was polished, Rev. Shuttlesworth was fiery. This obituary in the New York Times recounts his bravery from the early days of the civil rights struggle. 

In 2008, Birmingham named its principal airport after Rev. Shuttlesworth.

• Environmental groups sued yesterday to stop clearing of grasslands along the route of the proposed Keystone XL pipeline. The pipeline, which will carry oil sands oil from Canada to the Gulf Coast, cuts through several Great Plains states.

Environmental groups say construction has begun on the pipeline before it receives a final permit. 

• Three family farmers write in the St. Louis newspaper:

We are bitterly disappointed by the lack of leadership President Obama and the White House have demonstrated regarding America’s farm families and rural communities. Major case in point: a proposed rule to increase competition in the livestock industry has been delayed under this presidency for almost two years.

As family farmers, we see the trends in agriculture, aided by federal policy, that have led us to greater concentration and consolidation in many sectors of the industry. Whether it’s corporate livestock operations, massive cropping operations with tens of thousands of acres, undue influence of corporate agribusiness lobbyists, or what amounts to monopolies in meatpacking and food processing — these trends are not good for rural economies or our country. 

• Ballooning prices for farmland have federal banking officials concerned, Bloomberg reports.

Federal Reserve Bank of Kansas City officials are urging local banks to consider the risks of rapidly increasing land values. They are asking bank officials to consider what would happen to their financial positions if there was a sudden drop in land prices.

Bloomberg reports

Examiners at the regional Fed banks and the Federal Deposit Insurance Corp. are scrutinizing the lending standards, concentration levels, and loan documentation and risk management practices at the country’s 2,144 farm banks. Risks that could curb the frothy farmland prices include a punishing drought in some states and volatile global commodity markets that could plunge and strip away crop income.

 

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