Coverage Matters: Uninsured Children Face Worse TBI Outcomes
Uninsured Pediatric Traumatic Brain Injury Patients Have Higher Rate of Death from Injury Than Those with Private or Public Insurance
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Affecting more than 475,000 children each year, pediatric traumatic brain injury (pTBI) is the leading cause of serious disability and death in children. Now, a study by New York Medical College faculty published in Clinical Neurology and Neurosurgery reports that uninsured patients face more than a 12-fold higher risk of death than those with either private or public insurance.
“Insurance status has long been recognized as an important factor in pTBI outcomes, and our findings show that it is strongly associated with mortality,” says Carrie Muh, M.D., M.S., M.H.Sc., professor of neurosurgery and of pediatrics, and senior author on the study. “The differences we observed likely reflect a combination of factors related to their insurance status, including pre-injury baseline health status, injury characteristics, timing of presentation, and access to specialized resources across the continuum of care.”
The retrospective study examined the outcomes for 359 pTBI patients treated at Westchester Medical Center, the only Level I Pediatric Trauma Center in the Hudson Valley, from 2012 to 2023. Nearly half of the patients (49 percent) had private insurance, while 46 percent had public insurance, and five percent were uninsured. The researchers found that uninsured patients experienced significantly worse outcomes, including more serious and potentially life-threatening injuries prior to arrival to the hospital, longer hospital stays, and a dramatically higher rate of death. Among the uninsured patients, the mortality rate was nearly 28 percent, versus just over two percent for privately insured patients and a half percent for those with public insurance.
While private insurance generally offers comprehensive coverage, including trauma care, rehabilitation services, and specialized procedures, and public insurance, such as Medicaid, provides essential health benefits with some limitations in coverage and health provider network availability, uninsured patients rely on safety-net programs, which mandate emergency stabilization but do not ensure access to the full spectrum of post-acute or specialized trauma services.
“Identifying where gaps in care and access occur for uninsured children is an important step toward improving outcomes,” says Dr. Muh. “Our results show a strong association between insurance status and mortality for children with traumatic brain injury. This highlights the need for earlier intervention, improved care coordination, and prevention strategies to help reduce disparities in this vulnerable population.”
