Abstract

Traumatic injury leads to significant disability, with injured patients often requiring substantial healthcare resources to return to work and baseline health. Temporary disability or inability to work can result in changes or loss of employer-based private insurance coverage, which may significantly impact healthcare access and outcomes. Among privately insured patients, we hypothesized increased instability in insurance coverage for patients with higher severity of injury.Adults 18 years and older presenting to a hospital with traumatic injury were evaluated for insurance churn using Clinformatics® Data Mart private-payer claims. Insurance churn was defined as cessation of enrollment in the patient's private health insurance plan. Using injury severity score (ISS), we compared insurance churn over the year following injury between patients with mild (ISS <9), moderate (ISS 9-15), severe (ISS 16-24), and very severe (ISS > 24) injuries. Kaplan-Meier analysis was used to compare time to insurance churn by ISS category. Flexible parametric regression was used to estimate hazard ratios for insurance churn.Among 750,862 privately insured patients suffering from a traumatic injury, 50% experienced insurance churn within 1 year after injury. Compared to patients who remained on their insurance plan, patients who experienced insurance churn were younger and more likely male and non-White. The median time to insurance churn was 7.7 months for those with mild traumatic injury, 7.5 months for moderately or severely injured, and 7.1 months for the very severely injured. In multivariable analysis, increasing injury severity was associated with higher rates of insurance churn compared with mild injury, up to 14% increased risk for the very severely injured.Increasing severity of traumatic injury is associated with higher levels of health coverage churn amongst the privately insured. Lack of continuous access to health services may prolong recovery and further aggravate the medical and social impact of significant traumatic injury.Economic/decision study, Level II.

View details for DOI 10.1097/TA.0000000000003861

View details for PubMedID 36623273