The American Hospital Association (AHA) defines uncompensated care (UC) as the overall measure of hospital care provided for which no payment was received from the patient or insurer. Previous studies have suggested that there is a correlation between inadequate reimbursement and patient transfer practices. Trauma-related healthcare costs and trauma-specific administrative expenses threaten to overwhelm institutions treating large numbers of uninsured, severely injured patients. 3 In the USA, trauma-related healthcare expenditures are second only to those related to cardiovascular disease. 2 Given the low reimbursement rates for patients without insurance, trauma centers are often considered the most financially vulnerable healthcare entities. National estimates suggest one in five trauma patients lacks health insurance. Unfortunately, by 2017 the number of individuals without insurance coverage started to rise again. As a result, the number of uninsured patients nationwide decreased. In 2014, the Affordable Care Act (ACA) expanded coverage to nearly 20 million of previously uninsured Americans through the expansion of Medicaid and the establishment of the Health Insurance Marketplace. In 2013, an estimated 44 million Americans lacked health insurance coverage. Gaps in the public insurance system and the lack of affordable private coverage have left millions of Americans without health insurance.
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