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Mental Illness, Traumatic Brain Injury, and Medicaid Expenditures

      Abstract

      Wei W, Sambamoorthi U, Crystal S, Findley PA. Mental illness, traumatic brain injury, and Medicaid expenditures.

      Objective

      To estimate the rates of mental illness among Medicaid beneficiaries with traumatic brain injury (TBI) and associated Medicaid-paid expenditures.

      Design

      Retrospective claims-based calendar year data.

      Setting

      Claims data.

      Participants

      Medicaid recipients with diagnosed TBI and mental illness who received Medicaid services in 4 states in 1995.

      Interventions

      Not applicable.

      Main outcome measures

      Annual expenditures for total, inpatient, and noninpatient services, as derived from Medicaid personal summary files. Mental illness and TBI were identified by using International Classification of Diseases, 9th Revision, Clinical Modification codes recorded in Medicaid claims.

      Results

      Of a total of 493,663 Medicaid recipients, 3641 (0.7%) were diagnosed with TBI in the 4 states. Significant demographic and racial differences were found in the rates of TBI; 18% of patients with TBI were diagnosed with serious mental illness. People with TBI in the age group 40 to 49 years were more likely to have a mental disorder. There were significant differences in estimated total, inpatient, and noninpatient expenditures between those with and without mental illness. In general, those with serious mental illness had higher Medicaid-paid expenditures than those without any mental illness.

      Conclusions

      Psychiatric comorbidity in TBI increases the overall expenditures in this population. This increased cost is an important consideration in programming for those with TBI.

      Key words

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      References

      1. Rosenthal M. Griffith E.R. Kreutzer J.S. Pentland B. Rehabilitation of the adult and child with traumatic brain injury. FA Davis, Philadelphia1998
        • Sorenson S.B.
        • Kraus J.F.
        Occurrence, severity and outcomes of brain injury.
        J Head Trauma Rehabil. 1991; : 1-10
        • Max W.
        • MacKenzie E.
        • Rice D.
        Head injuries.
        J Head Trauma Rehabil. 1991; : 76-91
        • Ragnarsson K.T.
        Results of the NIH consensus conference on “rehabilitation of persons with traumatic brain injury.”.
        Restor Neurol Neurosci. 2002; 20: 103-108
        • Fordyce D.J.
        • Roueche J.R.
        • Prigatano G.P.
        Enhanced emotional reactions in chronic head trauma patients.
        J Neurol Neurosurg Psychiatry. 1983; 46: 620-624
        • Prigatano G.
        Neuropsychological rehabilitation after brain injury. Johns Hopkins Pr, Baltimore1986
        • Fann J.R.
        • Burington B.
        • Leonetti A.
        • Jaffe K.
        • Katon W.J.
        • Thompson R.S.
        Psychiatric illness following traumatic brain injury in an adult health maintenance organization population.
        Arch Gen Psychiatry. 2004; 61: 53-61
        • Deb S.
        • Lyons I.
        • Koutzoukis C.
        • Ali I.
        • McCarthy G.
        Rate of psychiatric illness 1 year after traumatic brain injury.
        Am J Psychiatry. 1999; 156: 374-378
        • Fann J.R.
        • Katon W.J.
        • Uomoto J.M.
        • Esselman P.C.
        Psychiatric disorders and functional disability in outpatients with traumatic brain injuries.
        Am J Psychiatry. 1995; 152: 1493-1499
        • Hibbard M.R.
        • Uysal S.
        • Kepler K.
        • Bogdany J.
        • Silver J.
        Axis I psychopathology in individuals with traumatic brain injury.
        J Head Trauma Rehabil. 1998; 13: 24-39
        • Schoenhuber R.
        • Gentilini M.
        Anxiety and depression after mild head injury.
        J Neurol Neurosurg Psychiatry. 1988; 51: 722-724
        • van Zomeren A.H.
        • van den Burg W.
        Residual complaints of patients two years after severe head injury.
        J Neurol Neurosurg Psychiatry. 1985; 48: 21-28
        • Dikmen S.
        • McLean A.
        • Temkin N.
        Neuropsychological and psychosocial consequences of minor head injury.
        J Neurol Neurosurg Psychiatry. 1986; 49: 1227-1232
        • van Reekum R.
        • Bolago I.
        • Finlayson M.A.
        • Garner S.
        • Links P.S.
        Psychiatric disorders after traumatic brain injury.
        Brain Inj. 1996; 10: 319-327
        • Corrigan J.D.
        Substance abuse as a mediating factor in outcome from traumatic brain injury.
        Arch Phys Med Rehabil. 1995; 76: 302-309
        • Kreutzer J.S.
        • Witol A.D.
        • Marwitz J.H.
        Alcohol and drug use among young persons with traumatic brain injury.
        J Learn Disabil. 1996; 29: 643-651
        • Kreutzer J.S.
        • Wehman P.H.
        • Harris J.A.
        • Burns C.T.
        • Young H.F.
        Substance abuse and crime patterns among persons with traumatic brain injury referred for supported employment.
        Brain Inj. 1991; 5: 177-187
        • Mooney G.
        • Speed J.
        The association between mild traumatic brain injury and psychiatric conditions.
        Brain Inj. 2001; 15: 865-877
        • Malaspina D.
        • Goetz R.R.
        • Friedman J.H.
        • et al.
        Traumatic brain injury and schizophrenia in members of schizophrenia and bipolar disorder pedigrees.
        Am J Psychiatry. 2001; 158: 440-446
        • Rowland D.
        • Garfield R.
        • Elias R.
        Accomplishments and challenges in Medicaid mental health.
        Health Aff (Millwood). 2003; 22: 73-83
        • Frank R.G.
        • Goldman H.H.
        • Hogan M.
        Medicaid and mental health.
        Health Aff (Millwood). 2003; 22: 101-113
      2. Traumatic Brain Injury Model System. TBI research review: policy & practice. Vol 1. New York; 2004. p 1–4.

        • Chan L.
        • Doctor J.
        • Temkin N.
        • et al.
        Discharge disposition from acute care after traumatic brain injury.
        Arch Phys Med Rehabil. 2001; 82: 1151-1154
        • Reynolds W.E.
        • Page S.J.
        • Johnston M.V.
        Coordinated and adequately funded state streams for rehabilitation of newly injured persons with TBI.
        J Head Trauma Rehabil. 2001; 16: 34-46
        • Connors S.
        • King A.
        • Vaughn S.
        Guide to state government brain injury policies, funding and services. National Association of State Head Injury Administrators, Bethesda2003
        • Kessler R.C.
        • Berglund P.A.
        • Walters E.E.
        • et al.
        A methodology for estimating the 12-month prevalence of serious mental illness.
        in: Manderscheid R.W. Henderson M.J. Mental health. Center for Mental Health Services, Rockville1998: 99-109
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies.
        J Chronic Dis. 1987; 40: 373-383
        • Deyo R.A.
        • Cherkin D.C.
        • Ciol M.A.
        Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.
        J Clin Epidemiol. 1992; 45: 613-619
        • Sambamoorthi U.
        • Collins S.
        • Crystal S.
        Dually eligible individuals with AIDS.
        J Health Soc Policy. 2001; 14: 19-35
        • Yanos P.T.
        • Crystal S.
        • Kumar R.
        • Walkup J.T.
        Characteristics and service use patterns of nonelderly Medicare beneficiaries with schizophrenia.
        Psychiatr Serv. 2001; 52: 1644-1650
        • Sherer M.
        • Hart T.
        • Nick T.G.
        • Whyte J.
        • Thompson R.N.
        • Yablon S.A.
        Early impaired self-awareness after traumatic brain injury.
        Arch Phys Med Rehabil. 2003; 84: 168-176
        • Corrigan J.D.
        • Harrison-Felix C.
        • Bogner J.
        • Dijkers M.
        • Terrill M.S.
        • Whiteneck G.
        Systematic bias in traumatic brain injury outcome studies because of loss to follow-up.
        Arch Phys Med Rehabil. 2003; 84: 153-160
        • Hoffman J.M.
        • Doctor J.N.
        • Chan L.
        • Whyte J.
        • Jha A.
        • Dikmen S.
        Potential impact of the new Medicare prospective payment system on reimbursement for traumatic brain injury inpatient rehabilitation.
        Arch Phys Med Rehabil. 2003; 84: 1165-1172
        • Johnstone B.
        • Mount D.
        • Schopp L.H.
        Financial and vocational outcomes 1 year after traumatic brain injury.
        Arch Phys Med Rehabil. 2003; 84: 238-241
        • Mayer N.H.
        • Pelensky J.
        • Whyte J.
        • Fidler-Sheppard R.
        Characterization and correlates of medical and rehabilitation charges for traumatic brain injury during acute rehabilitation hospitalization.
        Arch Phys Med Rehabil. 2003; 84: 242-248
        • Seel R.T.
        • Kreutzer J.S.
        • Rosenthal M.
        • Hammond F.M.
        • Corrigan J.D.
        • Black K.
        Depression after traumatic brain injury.
        Arch Phys Med Rehabil. 2003; 84: 177-184
        • Appelbaum P.S.
        The ‘quiet’ crisis in mental health services.
        Health Aff (Millwood). 2003; 22: 110-116
        • Kaiser Commission on Medicaid and the Uninsured
        Medicaid’s role for women. Kaiser Commission, Washington (DC)Nov 2002
        • Vaughn S.L.
        • King A.
        A survey of state programs to finance rehabilitation and community services for individuals with brain injury.
        J Head Trauma Rehabil. 2001; 16: 20-33