Insurance coverage could affect survival of patients with spinal cord injury

Treating people with severe spinal cord injuries can cost hundreds of thousands of dollars, and a new analysis suggests that ability to pay influences how long a patient remains on life support.

In a study of more than 8,400 American adults with severe spinal cord injuries, “uninsured patients were more likely to have life-sustaining treatment withdrawn” than those with private insurance, researchers said.

The results were published in the journal JAMA Surgery.

According to the study’s background information, an estimated 1.3 million people in North America are affected by a spinal cord injury, which can often lead to irreversible paralysis. Other medical problems such as breathing difficulties can also occur.

Caring for these people can require a lot of staff and complex, expensive technologies.

All of this can result in high medical bills: “In the United States, the cost of acute care for spinal cord injuries is estimated to range from $92,220 to $337,400, with the higher amount reportedly corresponding to a higher level of neurological injury.”

The new study was led by Dr. Christopher Witiw, an assistant professor of surgery at the University of Toronto. His team wondered whether the duration of life support is affected by the level and type of insurance coverage a U.S. patient has.

To find out, they examined data from the American College of Surgeons from 2013 to 2020. It included the treatment outcomes and insurance status of 8,421 people aged 16 and older, all of whom were treated for a spinal cord injury. The data came from 498 different trauma centers.

Most patients (80%) were male and on average 49 years old.

Witiw’s team found that over the course of the study, patients without insurance were 49 percent more likely to be taken off life support than those with private insurance.

The study also found that patients without insurance coverage were 98 percent more likely to die during the study period than those with private insurance.

In other words, just over 22% of the 940 patients without insurance had life support withdrawn and almost 34% died.

For those with private insurance, these figures were 14.3% and 21.5% respectively.

According to the study, the contributions for those with statutory insurance (Medicaid, Medicare) were somewhere between those of those with private insurance and those without insurance. Privately insured people fared significantly better than those with statutory insurance in terms of the lower rate of complications in hospital and the longer length of hospital stay.

All of these findings “highlight potential insurance-related differences in outcomes following complete cervical spinal cord injury,” Witiw’s group concluded.

The decision to withdraw life support is, of course, heartbreaking and of vital importance, since “97.5% of patients who were withdrawn from life support ultimately died,” the researchers noted.

“The decision to withdraw life support is complex and requires shared decision-making between patients, families and physicians, with respect for patient autonomy paramount,” the authors said.

Does the ability to pay rising medical bills play a role in these decisions?

The researchers noted that it is difficult to separate economic barriers from other factors that may influence decisions regarding life-sustaining care, such as the cultural or religious beliefs of patients and their doctors, and “expectations regarding recovery.”

However, Witiw’s group said, “future work is needed to incorporate patient perspectives and develop strategies to close the quality gap (in spinal cord injury care) for the large number of patients without private health insurance.”

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