Annemarie Relyea-Chew, Presenter: Nothing to Disclose

William Hollingworth PhD, Abstract Co-Author: Nothing to Disclose

Jeffrey Gil Jarvik MD, MPH, Abstract Co-Author: Founder, Allez PhysiOnix, Ltd Stockholder, Allez PhysiOnix, Ltd

Medical imaging is a key driver in the increasing proportion of GDP expended on health care in the US. We have demonstrated that the incidence of individual bankruptcy increases after hospital admission subsequent to serious injury. The role of uninsured medical bills in bankruptcy is unclear.

This retrospective case-control study examined bankruptcy petitions of debtors with traumatic brain or spinal cord injuries admitted to a Level 1 trauma center and compared them to non-injured debtors. All debtors filed bankruptcy petitions in the Western District of Washington State. We reviewed the petitions of the debtor-patients (N=81) who filed for bankruptcy within 5 years of hospitalization and between the years 2001 and 2004. The non-injured controls (N=80) were randomly selected from all bankruptcy filings during the same period. Trauma registry data were linked to the bankruptcy database using social security identifiers. We compared net wealth, medical debt and current income between cases and controls, and between cases with commercial and public insurance.

94 of 4372 patients admitted between 1996 and 2002 filed for bankruptcy within 5 years. At the time of bankruptcy injured cases had fewer assets than controls (median $11,000 vs $30,000, p<.01). Cases had significantly lower total debt (median $40,000 vs $81,000, p<.05). There was no significant difference in household net income or expenses between cases and controls. Median medical debt in the injured group was $1200; by comparison, the median medical debt in the control group was $0 (p<.01). Median medical debt did not vary between those with commercial insurance and public insurance (median $1200 vs $1200, p=.61). Median medical debt was higher in more severe injuries (median $1900 vs $300, p=.04).

Injured patients accumulate medical debt that can lead to bankruptcy despite public or commercial insurance. Median medical debt levels were relatively low but significantly higher than randomly selected controls. A more comprehensive medical insurance system might reduce the number of patients who file for bankruptcy.

Physicians should consider the financial impact on patients when ordering medical imaging.

Relyea-Chew, A, Hollingworth, W, Jarvik, J, Traumatic Brain or Spinal Cord Injury Followed by Personal Bankruptcy: The Role of Uninsured Medical Bills.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5011974.html