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Research Letter |

Continuity of Private Health Insurance Coverage After Traumatic Brain Injury

Joseph A. Lin, MPH1; Joseph K. Canner, MHS1; Eric B. Schneider, PhD1,2
[+] Author Affiliations
1Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
2Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Surg. 2016;151(7):678-680. doi:10.1001/jamasurg.2016.0040.
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This study examines the traumatic brain injury–related factors associated with accelerated change in health insurance coverage and the differences in time to coverage change among individuals with employer-provided private insurance.

Traumatic brain injury (TBI) accounts for 2.5 million emergency department visits, 280 000 hospitalizations, and 52 000 deaths in the United States each year, with approximately 40% of survivors developing some level of disability.1,2 Post-TBI disability in adults can lead to loss of employment and disruption of employment-based health insurance, which may affect ongoing care and can be devastating to policyholders and dependents. Even individuals sufficiently disabled by TBI to qualify for Medicare may face substantial delays in eligibility and access to care after loss of private coverage.3 The chronic nature of many post-TBI health issues underscores the importance of coverage continuity.4 We examined TBI-related factors associated with accelerated coverage change and differences in time to coverage change among individuals with employer-provided private insurance.

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Figure.
Weighted Kaplan-Meier Curves of Change in Coverage Comparing Enrollees With Traumatic Brain Injury (TBI) With Enrollees Without TBI

All P values are log-rank P values. A, Survival functions are significantly different (P < .001). B, Each stratum of Abbreviated Injury Scale (AIS) score among enrollees with TBI is significantly different from enrollees without TBI (P < .001). Enrollees with TBI who had an AIS score of 3 and those who had an AIS score of 4 are not significantly different (P = .70). Enrollees with TBI who had an AIS score of 5 or 6 are significantly different from enrollees with TBI who had an AIS score of 3 or 4 (P = .01).

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