Abstract
Individuals having sustained traumatic spinal cord injury (TSCI) in the United States are living longer as compared to historical trends, thanks to an ever-evolving understanding of the nature of this injury. Despite this, multiple barriers to care for TSCI patients remain including variations in government-issued veteran insurance, privatized insurance, and among uninsured individuals. The United States alone experiences 12,000 new TSCI cases every year, many of these are found to occur in a growing proportion of elderly individuals. It is crucial to understand both the short-term direct costs as wells as the long-term rehabilitation costs required by these TSCI patients. The lifetime financial burden for those having sustained a TSCI can be immense for patients, insurance companies, and hospital systems alike. Among those with TSCI, re-hospitalization rates are high, leading to increased healthcare resource utilization within this specific patient population. Costs can quickly balloon into hundreds of thousands of dollars and cause a profound financial burden for these patients. This review article seeks to communicate an understanding of the current financial landscape surrounding TSCI patients. The authors will also examine the costs of acute emergency room surgical care such as American spinal injury association grade, hospital length of stay, as well as the timing delay between injury and surgical decompression. Long-term costs associated with TSCI such as rehabilitation, care of secondary comorbidities, and post-injury employment prospects will be examined as well. These costs will be framed from the patient’s perspective as well as from both the hospital and insurance company’s perspectives. It is hoped a complete understanding as to what makes TSCI such a medically and financially burdensome injury will allow for improved healthcare resource utilization in this population.
Highlights
To begin a discussion of the economic impact of traumatic spinal cord injury (TSCI), it becomes necessary to first have an understanding of the epidemiology and disease burden of TSCI
Access to rehabilitation can be difficult through certain forms of insurance, it is critical in TSCI care
Lack of rehabilitation services has been associated with greater levels of comorbid secondary health conditions
Summary
To begin a discussion of the economic impact of traumatic spinal cord injury (TSCI), it becomes necessary to first have an understanding of the epidemiology and disease burden of TSCI. A prospective cohort study investigating the relationship between the delay of surgical decompression following TSCI and neurological recovery found that decompression within the first 24 h more than doubled the chance of recovery of a 2 ASIA grade TSCI as compared to those who received spinal cord decompression outside of this 24 h window[15,17]. A study comparing the risk of bankruptcy before and after TSCI found that patients sustaining a TSCI have a 3.5% chance of bankruptcy in the first five years post-injury. Those with private insurance were twice as likely to file for bankruptcy as compared to those with Medicaid. Patients following a TSCI may have altered decision making capabilities due to the increased incidence of MDD[70]
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