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Trauma Funds Must Not be Ignored Again

ATLANTA -- Despite a staggering economy and declining tax revenue, Georgia must not turn its back again on funding for its troubled network of trauma hospitals.

It was heartening to hear state Insurance Commissioner John Oxendine, a Republican who wants to be governor in 2010, recently suggest a surcharge on vehicle insurance policies that would serve as a permanent funding source for the network. Oxendine said he wasn't necessarily endorsing insurance fees to pay for the network, but he and other Republicans agreed at a forum on trauma care last month that a dedicated fee of some sort would be needed to improve the system.

That's a major step for GOP officeholders, whose leaders in the past have decried dedicated fees or taxes for trauma care as an unworthy "entitlement" sought by hospitals. In both the 2007 and 2008 sessions of the General Assembly, the Republican leadership failed to make good on promises that the financially strapped network would finally get some long-term support from the state. The 20-year-old network has lost a half dozen hospitals over the years --- those facilities stopped providing the service --- because they could no longer absorb the cost of care for patients without insurance.

The 2008 session reneged on the most recent promise and adjourned with a one-time appropriation of $59 million to prop up the system, once again vowing to revisit the issue in 2009. But by the summer, the bottom fell out of the state's revenue projections, prompting Gov. Sonny Perdue to demand across-the-board budget reductions at all state agencies.

That leaves the fate of future funds for trauma care very uncertain. Nevertheless, Oxendine --- perhaps sensing the widespread voter support for dedicated funds for trauma care --- was correct to keep the issue alive with his call for a fee or surcharge on insurance policies.

Oxendine told the forum that since motor vehicle accidents account for nearly two-thirds of all trauma care costs, a good case could be made to pay for improvements to the network by including a surcharge on all policies. Insurance companies can be expected to fight the idea and will pass the cost on to consumers if it is enacted. But a fully functioning, coordinated trauma care network could not only save lives in Georgia --- an estimated 700 per year, according to one study --- it could potentially lead to lower charges for all drivers.

In years past, the trauma network has spent much of its time begging for what little help it can get from the state to keep hospitals from dropping the service. What Georgia ought to be doing is figuring out how to get more hospitals into the network and coordinating their services in a much more systematic way.

Maryland, with one of the best trauma networks in the country, created an independent state agency to coordinate all components of a statewide EMS system, including 911 call centers, a statewide communications system and licensing and regulating commercial ambulance services. The Maryland system is fully funded by the state. Richmond, Va. created its own ambulance authority to coordinate services for its metro region in much the same way.

Georgia, on the other hand, has a loosely organized network of 15 trauma hospitals, some of them actually competing for patients, which heightens the tension over which centers get the paying customers and which get saddled with the uninsured. The network still lacks formal mechanisms to make sure ambulance providers, hospital emergency rooms and trauma centers are talking with each other in a way that ensures trauma patients are taken to the most appropriate facility.

To do that will take not just a change in the way the network is organized, but a dedicated source of permanent funds, probably amounting to between $150 million to $200 million a year. The network will need to know it can depend on state money every year, not just in those years when the General Assembly feels like it can afford to toss a few dollars its way. Whether that's accomplished by Oxendine's idea of an insurance surcharge, or a $10 fee on vehicle license tags each year, or any other of the ideas that have been suggested is less relevant than the Legislature first agreeing that some dedicated source of money is needed.

Unless there is a dramatic turnaround in the economy, when the 2009 session convenes next January there will be little talk of spending for new state programs. But voters should not allow the long-delayed promise to improve Georgia's trauma network to be taken off the table. The way to do that is to go into the session with a plan that is designed to save both lives and money. Oxendine has taken the first political step in that direction. Other state political leaders should publicly join him.


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