Personal Bankruptcy After Traumatic Brain or Spinal Cord Injury: The Role of Medical Debt

Abstract

Relyea-Chew A, Hollingworth W, Chan L, Comstock BA, Overstreet KA, Jarvik JG. Personal bankruptcy after traumatic brain or spinal cord injury: the role of medical debt.

Objective

To estimate the prevalence of medical debt among traumatic brain injury (TBI) and spinal cord injury (SCI) patients who discharged their debts through bankruptcy.

Design

A cross-sectional comparison of bankruptcy filings of injured versus randomly selected bankruptcy petitioners.

Setting

Patients hospitalized with SCI or TBI (1996–2002) and personal bankruptcy petitioners (2001–2004) in western Washington State.

Participants

Subjects (N=186) who filed for bankruptcy, comprised of 93 patients with previous SCI or TBI and 93 randomly selected bankruptcy petitioners.

Interventions

Not applicable.

Main Outcome Measures

Medical and nonmedical debt, assets, income, expenses, and employment recorded in the bankruptcy petition.

Results

Five percent of randomly selected petitioners and 26% of petitioners with TBI or SCI had substantial medical debt (debt that accounted for more than 20% of all unsecured debts). SCI and TBI petitioners had fewer assets and were more likely to be receiving government income assistance at the time of bankruptcy than controls. SCI and TBI patients with a higher blood alcohol content at injury were more likely to have substantial medical debts (odds ratio=2.70; 95% confidence interval, 1.04–7.00).

Conclusions

Medical debt plays an important role in some bankruptcies after TBI or SCI. We discuss policy options for reducing financial distress after serious injury.

Key Words: Brain injuries, Health care costs, Insurance, health, Rehabilitation, Spinal cord injuries

List of Abbreviations: GCS, Glasgow Coma Score, IQR, interquartile range, ISS, Injury Severity Score, SCI, spinal cord injury, SNF, skilled nursing facility, SSN, social security number, TBI, traumatic brain injury

a Department of Radiology, University of Washington, Seattle, WA

b Department of Medicine, University of Washington, Seattle, WA

c Department of Health Services, University of Washington, Seattle, WA

d Department of Neurological Surgery, University of Washington, Seattle, WA

e Department of Center for Cost and Outcomes Research, University of Washington, Seattle, WA

f Department of Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA

g Department of Social Medicine, University of Bristol, Bristol, UK

h Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, MD

i U.S. Bankruptcy Court, Western District of Washington, Seattle, WA

Correspondence to William Hollingworth, PhD, Dept of Social Medicine, University of Bristol, Canynge Hall, Bristol, BS8 2PR, UK.

Supported by the Royalty Research Fund of the University of Washington and the intramural research program of the National Institutes of Health.

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

Reprints are not available from the author.

PII: S0003-9993(08)01633-X

doi:10.1016/j.apmr.2008.07.031

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