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)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The financial trauma of head injury.Brain Inj. 1988; 2: 357-364
- Bankruptcy statistics.(Accessed February 12, 2008)
- The fragile middle class: Americans in debt.Yale Univ Pr, New Haven2000
- The household bankruptcy decision.Am Econ Rev. 2002; 92: 706-718
- Determinants of the consumer bankruptcy decision.J Finance. 1999; 54: 403-420
- The risk of bankruptcy before and after brain or spinal cord injury: a glimpse of the iceberg's tip.Med Care. 2007; 45: 702-711
- Illness and injury as contributors to bankruptcy.Health Aff (Millwood). 2005; (Jan-Jun;Suppl Web Exclusives:W5-63-W5-73)
- Statistical validation of the Glasgow Coma Score.J Trauma. 2006; 60: 1238-1243
- The injury severity score: an update.J Trauma. 1976; 16: 882-885
- An overview of the injury severity score and the new injury severity score.Inj Prev. 2001; 7: 10-13
- Factors associated with higher levels of injury severity in occupants of motor vehicles that were severely damaged in traffic crashes in Kentucky, 2000-2001.Traffic Inj Prev. 2004; 5: 144-150
- Functional outcome after blunt and penetrating carotid artery injuries: analysis of the National Trauma Data Bank.J Trauma. 2005; 59: 860-864
- Household catastrophic health expenditure: a multicountry analysis.Lancet. 2003; 362: 111-117
- Financial and vocational outcomes 1 year after traumatic brain injury.Arch Phys Med Rehabil. 2003; 84: 238-241
- Family stressors in traumatic brain injury: a two-year follow-up.Arch Phys Med Rehabil. 1994; 75: 876-884
- Medical bankruptcy: myth versus fact.Health Aff (Millwood). 2006; 25: w74-w83
- An act relating to insurance coverage for injuries sustained because of alcohol or narcotic use.HB 2014. 2004 (Accessed February 18, 2009)
- Screening trauma patients for alcohol problems: are insurance companies barriers?.J Trauma. 2000; 48: 115-118
- Health benefits in 2003: premiums reach thirteen-year high as employers adopt new forms of cost sharing.Health Aff (Millwood). 2003; 22: 117-126
- State-specific prevalence of lapses in health-care-insurance coverage–United States, 1995.JAMA. 1998; 279: 822-824
- Short-term impacts of coverage loss in a Medicaid population: early results from a prospective cohort study of the Oregon Health Plan.Ann Fam Med. 2006; 4: 391-398
- Health policy for low-income people: states' responses to new challenges.Health Aff (Millwood). 2002; (Jul-Dec;Suppl Web Exclusives:W187-218)
- Workers' risk of unemployment after traumatic brain injury: a normed comparison.J Int Neuropsychol Soc. 2005; 11: 747-752
- Race, employment, and spinal cord injury.Arch Phys Med Rehabil. 2004; 85: 1782-1792
- Consumer Credit.(Accessed December 2, 2008)
- Marital stability after brain injury: an investigation and analysis.NeuroRehabilitation. 2007; 22: 53-59
- A legislative history of the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005.Am Bankruptcy Law J. 2005; 79: 485-570
- It's the premiums, stupid: projections of the uninsured through 2013.Health Aff (Millwood). 2005; (Jan-Jun;Suppl Web Exclusives:W5-143-W5-151)
- Institute of Medicine, National Academies Pr, Washington (DC)2004
- Emergency department use and subsequent hospitalizations among members of a high-deductible health plan [published erratum appears in JAMA 2008;299:171].JAMA. 2007; 297: 1093-1102
- Proposal of the physicians' working group for single-payer national health insurance.JAMA. 2003; 290: 798-805
Article info
Footnotes
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.
Identification
Copyright
© 2009 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
