Loss of Insurance Following Central Nervous System Trauma

Introduction: Patients experiencing central nervous system (CNS) trauma may represent a group that insurance fails to protect from catastrophic medical expenses, resulting in the transfer of financial burden onto families and public payers. This study compared rates of insurance discontinuation in patients with surgically managed traumatic spinal cord injury (SCI) and brain injury (TBI) to those in matched controls.

Methods: The MarketScan database was queried from 2006-2021. Admissions for patients sustaining TBI and SCI with and without concomitant bony trauma requiring surgical management were identified using ICD and CPT codes. Next, propensity scores were used to identify matched controls based on age, sex, comorbidities, geographic region, year of insurance enrollment, and insurance plan type. Kaplan-Meier survival analysis assessed the time between a patient’s index admission and insurance discontinuation. Cox proportional-hazards regression determined hazard ratios (HR) for insurance discontinuation among SCI and TBI patients relative to matched controls.

Results: The TBI cohort included 3668 patients, 544 (14.8%) of whom sustained concomitant skull fractures. The SCI cohort included 1230 patients, and 274 (22.2%) had a simultaneous vertebral fracture or dislocation. Relative to matched controls, patients sustaining TBI with (HR: 1.94, 95% CI:1.77-2.12, p < 0.0001) and without (HR: 1.72, 95% CI:1.63-1.80, p < 0.001) a skull fracture, as well as patients with SCI with (HR: 1.76, 95% CI: 1.54-2.01, p< 0.0001) and without (HR: 1.47, 95% CI: 1.35-1.60, p< 0.0001) spine trauma, were more likely experience insurance discontinuation. TBI and SCI patients had continuous insurance for a mean of 553 and 612 days following their injuries compared to 1034 and 991 days in their respective matched control cohorts (p < 0.0001; p< 0.0001).

Conclusion : Rates of insurance discontinuation were significantly higher for patients with traumatic SCI and TBI compared with matched controls, indicating that patients with disabling CNS injuries are at increased risk for loss of insurance.