For people without health care, sustaining a traumatic injury can mean a lower standard of care, but a new study published on Wednesday in JAMA Surgery suggests that insured patients are even more likely to receive insufficient trauma care than uninsured trauma patients.

The study found that uninsured patients with severe injuries were more likely to be transported out of hospitals that did not specialize in trauma care than insured trauma victims.

“This is one scenario where the uninsured may not be worse off,” said M. Kit Delgado, an emergency medicine specialist at the University of Pennsylvania and lead author for the study.

The study consisted of Delgado and other colleagues reviewing more than 4,000 records from adult trauma patients, age 65 and younger, who were treated at 636 non-trauma hospitals. Delgado says that while 75 percent of U.S. hospitals are non-trauma hospitals, that are the same hospitals where roughly one-third of trauma patients receive their initial treatment.

While the study was critiqued regarding its suggestion that hospitals choose to admit or transfer patients based on their insurance, one problem raised by the study raises a much bigger question: Why aren’t hospitals sending trauma patients to hospitals specializing in trauma care, when they know that there is only a 25 percent survival advantage for trauma patients at community hospitals.

Charles Mabry, a surgeon at the University of Arkansas, says that with a shortage of surgeons at many hospitals, he anticipates more trauma patients will begin to be transferred out to hospitals specializing in trauma care. Also, as the Affordable Care Act’s presence grows and more Americans become insured, this too could change the type of care received by trauma care patients, Mabry noted.