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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

      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)
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