|
 Examining a three-year period, researchers also found that the more
severe the brain injury, the quicker people lost or saw changes in
their health coverage.
Most subjects received health insurance through their jobs, so any
change in coverage was likely due to changes in their employment,
say the authors of the research letter in JAMA Surgery.
“Individuals who were the primary policy holder might have lost
coverage because they were unable to continue in their job and
became unemployed/uninsured,” co- author Eric Schneider of Brigham
and Women’s Hospital and Harvard Medical School in Boston told
Reuters Health by email.
Traumatic brain injuries account for 2.5 million emergency room
visits and 280,000 hospitalizations each year in the U.S., the study
team writes. Around 40 percent of traumatic brain injury survivors
develop a disability, which can disrupt their ability to work, the
researchers note.
Schneider and his colleagues analyzed data from MarketScan, a
national commercial database of people with private health insurance
and their insurance claims. The team looked at the period between
January 2010 and December 2012, comparing 13,558 people under age 65
and treated for traumatic brain injury to similar individuals who
did not experience TBI during that period.
The researchers found that 30.7 percent of people who suffered TBI
had changes in their insurance coverage, compared to 27.6 percent of
their counterparts without TBI.
The data included diagnostic information about the degree of injury,
and the study team found that people with the most severe brain
injuries had the shortest time between getting hurt and an
experiencing an insurance change, at just under five months. People
without TBI averaged about 8.5 months before a shift in their
coverage.
For traumatic brain injury patients, continuing healthcare is
important, since treatment often continues long after the injury
occurs, said neurosurgeon Dr. Kimon Bekelis, an instructor at The
Dartmouth Institute for Health Policy and Clinical Practice in
Lebanon, New Hampshire.
“Some of these patients receive prolonged rehabilitation, whereas
others require frequent hospitalizations and multiple
re-operations,” said Bekelis, who was not involved in the study.
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Many patients may experience seizures and are prescribed costly
long-term medications, Bekelis said by email. “A potential
interruption of insurance coverage for these patients and their
dependents can have catastrophic consequences.”
For patients with more severe traumatic brain injuries, longer-term
treatment can make a big difference in their long-term recovery,
Schneider said.
“This suggests that having continuous coverage may be most important
to patients with the most severe injuries; however, in our study,
these are the severely injured individuals who were the quickest to
change (or lose) their pre-injury coverage,” he said.
The data did not include an explanation of why people changed
coverage status. It’s possible that health coverage could change for
a variety of reasons, including becoming eligible for different
insurance programs based on disability, Schneider said.
It’s also true that for some people, brain injuries may not be
serious, he noted. “For others, TBI can be a life-changing
experience with substantial long-term consequences that affect the
individual’s ability to work and function in their family and
society for the remainder of their lives. Continuous care can be
very important for individuals with TBI.”
“These findings should alert policy makers, payers, physicians, and
patients for this unrecognized and potentially dangerous source of
inefficient healthcare delivery,” Bekelis said.
SOURCE: bit.ly/1R7P80t JAMA Surgery, online March 2, 2016.
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