Section of Trauma and Critical Care, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, S067, Stanford, CA 94305.
Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, R291 MC 5327, Stanford, CA 94305. E-mail address:
J Bone Joint Surg Am. 2015 Jan 21;97(2):141-6. doi: 10.2106/JBJS.N.00148.
Spine trauma patients may represent a group for whom insurance fails to provide protection from catastrophic medical expenses, resulting in the transfer of financial burden onto individual families and public payers. This study compares the rate of insurance discontinuation for patients who underwent surgery for traumatic spine injury with and without spinal cord injury with the rate for matched control subjects.
We used the MarketScan database to perform a retrospective cohort study of privately insured spine trauma patients who underwent surgery from 2006 to 2010. Kaplan-Meier survival analysis was used to assess the time to insurance discontinuation. Cox proportional-hazards regression was used to determine hazard ratios for insurance discontinuation among spine trauma patients compared with the matched control population.
The median duration of existing insurance coverage was 20.2 months for those with traumatic spinal cord injury, 25.6 months for those with traumatic spine injury without spinal cord injury, and 48.0 months for the matched control cohort (log-rank p < 0.0001). After controlling for multiple covariates, the hazard ratios for discontinuation of insurance were 2.02 (95% CI [confidence interval], 1.83 to 2.23) and 2.78 (95% CI, 2.31 to 3.35) for the trauma patients without and with spinal cord injury, respectively, compared with matched controls.
Rates of insurance discontinuation are significantly higher for trauma patients with severe spine injury compared with the uninjured population, indicating that patients with disabling injuries are at increased risk for loss of insurance coverage.
脊柱创伤患者可能是一个群体，他们的保险无法为灾难性的医疗费用提供保障，从而将经济负担转嫁给个人家庭和公共支付方。本研究比较了因创伤性脊柱损伤接受手术治疗的患者（伴或不伴脊髓损伤）与匹配对照患者的保险终止率。
我们使用 MarketScan 数据库对 2006 年至 2010 年间接受手术治疗的私人保险脊柱创伤患者进行了回顾性队列研究。Kaplan-Meier 生存分析用于评估保险终止的时间。Cox 比例风险回归用于确定与匹配对照组相比，脊柱创伤患者保险终止的风险比。
伴脊髓损伤的患者现有保险覆盖的中位持续时间为 20.2 个月，不伴脊髓损伤的患者为 25.6 个月，匹配对照组为 48.0 个月（对数秩检验，p<0.0001）。在控制了多个协变量后，无脊髓损伤和伴脊髓损伤的创伤患者的保险终止风险比分别为 2.02（95%CI[置信区间]，1.83 至 2.23）和 2.78（95%CI，2.31 至 3.35），与匹配对照组相比。
与未受伤人群相比，严重脊柱损伤的创伤患者的保险终止率显著更高，这表明残疾性损伤的患者更有可能失去保险覆盖。
