Injury Severity

Injury Severity, Insurance and the Risk of Personal Bankruptcy

Hollingworth, PhD – Radiology and Pharmacy

Summary: Injury and illness are often cited as causes of bankruptcy. However, the incidence of bankruptcy after an acute medical event is unknown.

Objective: The study objectives were to determine the incidence of bankruptcy in survivors of brain and spinal cord trauma, identify vulnerable subgroups, and compare the incidence pre- and post-injury.

Design: Retrospective cohort study of patients injured from 1991 to 2002. Bankruptcy tracked from 1991 to 2004. SUBJECTS: Consecutive sample of 6345 adult residents of Western Washington State admitted to hospital with brain or spinal cord injuries. Measures: Multivariate Cox proportional hazard regression to examine incidence of bankruptcy 5 years post-injury. We used Poisson regression to measure the incidence rate ratio (IRR) of bankruptcy before and after injury in a subgroup of 3527 subjects.

Results: The incidence of bankruptcy 5 years post-injury was 3.5%. Bankruptcy was more frequent in patients with commercial medical insurance than those insured by Medicaid [hazard ratio (HR), 1.99; 95% confidence interval (CI), 1.47-2.70]. Bankruptcy was not consistently related to injury severity; patients with critical injuries tended to have a lower incidence of bankruptcy than those with mild injuries (HR, 0.65; CI, 0.41-1.03). Bankruptcy incidence was higher in younger patients and those with positive toxicology or moderately elevated blood alcohol concentration. Compared with pre-injury, there was a 33% increase in bankruptcy incidence post-injury (IRR, 1.33; CI, 0.94-1.89). The relative increase was highest in Medicaid patients (IRR, 2.32; CI, 1.09-4.95). Conclusions: The risk of bankruptcy post-injury is not negligible. There is an increase in bankruptcy post-injury, most evident in Medicaid patients. Better rehabilitation, workforce reintegration, and disability programs might reduce bankruptcy post-injury. (Medical Care 45(8), 702-711, 2007)