Future of spinal cord injury care in the United States

Abstract

The future of care for individuals with spinal cord injury will be affected by the sea change in health care that is already underway. The delivery of health care in the United States will undergo a degree and rate of change in the next decade never before experienced. Change will be demanded by the aging of the population and the related escalating demand for services. The Accountable Care Act, unless it is found unconstitutional by the Supreme Court, will also create demand by providing insurance to millions previously uninsured. This rising demand will exacerbate current and projected shortages in medicine, nursing, and other health professions, causing the educational system to reassess the efficiency and cost of educating these professionals. Another major driver of change is the rapidly growing budget deficit facing this nation and the world. There is no debate about the need to find ways to do more with less, only about the remedies required to address the challenges. While increased taxes may be part of the solution, substantial cuts and reallocation of spending priorities are an inescapable part of any responsible solution. Unnecessary utilization of services will be a major target in health care, causing consolidation among providers to achieve as many economies of scale as possible. What does all this mean for the future of spinal cord injury care? Amid turmoil lives opportunity. As funding priorities are reassessed and insurance mechanisms restructured, there are few conditions more compelling than spinal cord injury in terms of need and economic benefit related to investment. The field of spinal cord injury care and rehabilitation has the opportunity to unite to develop its case to convince legislators and policy makers of the prudence of investing wisely in treatment to avoid the unnecessary costs that predictably result from under investment. To do so, we must forego our fractured ways of lobbying for self-preservation of provider groups in favor of a united message that represents the interests of the individuals we serve. We must no longer sing solos, but collect our voices in a choir that can be heard above the noise that will swell as self-interest groups throughout health care compete intensely for shrinking resources. If well organized, we have a chance to be convincing about why adequate funding of care for spinal cord injury should be part of any sensible national health policy and the insurance options that arise from it. Join the choir! Get involved, pressure professional organizations like the Academy of Spinal Cord Injury Professionals to develop cogent arguments, forge strategic partnerships, and focus on real needs and achievable goals. Our priorities must be those programs and services that clearly improve outcomes. There will be casualties among providers, but better there than among the people with spinal cord injury. As professionals in spinal cord injury care and research, we shouldn't wait until we are forced to change. We have a duty to objectively evaluate how to best use the resources available to us. We should eliminate those services that don't improve outcomes, but that add to costs. We need to be more resourceful and eliminate our inefficiencies and reallocate resources to where they add value. This will ensure optimal care for people with catastrophic injuries and enable us to continue to build on the dramatic advances in research of the last decade. We will need help with issues like tort reform, but we can start now to face the realities of a future that need not be bleak. Above all, it will require the continued commitment of the many talented professionals who now dedicate themselves to improving the quality of life for those with spinal cord injury. More than ever before, individuals with spinal cord injury need your expertise, and they need you to apply it on a grander scale. Your devotion and commitment to persons with spinal cord injury is more necessary and more valued than ever.