Brain injury linked to increased risk of losing health insurance

A woman lies on an operating table during a brain surgery at the National Neurology Institute in Budapest (Copyright Reuters 2016)

- People who suffer traumatic brain injuries (TBI) are more likely to lose or change their private health insurance coverage just when they need it most, according to a recent U.S. analysis.

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.

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.