J. K. Canner1, E. R. Hammond5, E. B. Schnieder1,3,4, A. Asemota1, S. Selvarajah2 1Johns Hopkins University School Of Medicine,Surgery,Baltimore, MD, USA 2Kennedy Krieger Institute,International Center For Spinal Cord Injury,Baltimore, MD, USA 3Harvard School Of Medicine,Brookline, MA, USA 4Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 5Johns Hopkins University School Of Medicine,Psychiatry And Behavioral Sciences,Baltimore, MD, USA
Introduction: Individuals are at risk of losing their insurance if they are severely injured or have a disabling illness, such as following a traumatic spinal cord injury (TSCI). A factor that may affect patients’ ability to address all their healthcare needs following a TSCI, particularly the potential life-long need for neuro-rehabilitation to improve neurological and functional outcomes, is their insurance status. We sought to describe time to insurance loss after TSCI in a population with employer-sponsored insurance.
Methods: We used the 2010-2012 Truven Health Systems MarketScan® database which includes approximately 45 million patients under the age of 65 years who are covered through an employer-sponsored insurance plan. All hospitalized patients with a primary diagnosis of TSCI or a secondary diagnosis of TSCI accompanied by a primary diagnosis of other major trauma were included in the sample. Patients were followed in the database until discontinuation of enrollment in a MarketScan-affiliated insurance plan or until December 31, 2012, and the duration of insurance coverage was calculated. Log-rank tests and univariable Cox proportional hazards regression were used to compare TSCI patients with the general population and to compare the time to coverage loss for patients with and without spinal fracture and traumatic brain injury (TBI). Multivariable Cox proportional hazards regression was used to adjust for age, sex, and injury beneficiary status (e.g., employee, spouse, or child).
Results: A total of 5,231 patients were hospitalized for a TSCI during the study period. Of these, 44.8% had a primary diagnosis of TSCI, 70.5% had an associated vertebral fracture, and 21.0% had a complete TSCI. Two-thirds of the patients (67.1%) were male and the median age was 41 years (IQR: 23-54). An estimated 43.8% of the population with TSCI lost their insurance before the end of the study period, compared to 33.9% in the general population (HR=1.18, p<0.001). After adjusting for potential confounders, the hazard ratio was 1.23 (95% CI: 1.17-1.29, p<0.001). Among patients with a TSCI, there was no difference in the risk of insurance loss between those with and without a concomitant spinal fracture (HR=1.03, p=0.61), but there was a significant difference between those with and without a concomitant TBI (HR=1.17, p=0.026).
Conclusion: Approximately 4 in 10 patients with TSCI lost their employer-sponsored health insurance during the study period, a proportion significantly higher than that seen in the general population. Further research is needed to identify modifiable factors that could mitigate the extent of, and rate of loss of insurance among patients with TSCI.