Analyzing the Effect of State Legislation on Health Care Utilization for Children With Concussion
Gibson TB., Herring SA., Kutcher JS., Broglio SP. JAMA Pediatrics. Epub ahead of print.
Take Home Message: Legislation regulating pediatric concussion injury management seems to be effective. From 2009-20012 states with legislation had a 92% increase in concussion-related health care utilization while states without legislation had a 75% increase.
Washington enacted the first concussion injury legislation in 2009 (Lystedt Law) and by 2014 all states had a similar law. This is the first time that laws mandate medical attention for an injury but it is unclear how these laws affected injury reporting and health care utilization. Therefore, the authors sought to evaluate health care utilization rates for concussion from January 1, 2006 through June 30, 2012, in states with and without legislation. The authors analyzed the MarketScan Commercial Claims and Encounters database from January 1, 2005 through June 30, 2012. The database includes health insurance claims from all 50 states and DC. The authors focused on claims for children aged 12 to 18 years that had a concussion claim code. The authors assessed prelegislative trends in concussion-related health care utilization from January 1, 2006 through June 30, 2009, postlegislative trends from July 1, 2009 through June 30, 2012 in states with and without concussion legislation. Compared to prelegislative trends (2005-2009), the authors found that the rates of treated concussions in states without legislation were 7% higher in the 2009-2010 school year, 20% higher in the 2010-2011 school year, and 34% higher in the 2011-2012 school year. During the same time periods, the authors found a 10% increase in health care utilization for concussion in states with concussion laws compared to those without. From 2009-2012 the rate of office visits for concussion increased in states without legislation (15-78%) but it was 17% higher in states with laws in effect. However, neurologist visits were not different between states with and without concussion laws. Similarly, the authors found no differences between emergency department visits and CT scan rates between states with and without concussion laws, and the rates remained unchanged following implementation of the concussion law.
This is an important study because it demonstrates the influence of concussion legislation on concussion care in the youth population. The implementation of this legislation appears to have been effective in increasing medical attention devoted to concussion injures in children in the United States. From 2009-20012 states with legislation had a 92% increase in concussion-related health care utilization while states without legislation had a 75% increase. The authors estimated that about 40% of the increase in states without the legislation was related to increased media attention and increased concussion awareness. Additionally, some concussions in states without laws could have been missed in this study because athletic trainers were managing the concussion injuries without a physician visit. The rates of emergency room visits and CT scans remaining unchanged suggests that parents who are seeking medical attention for their child are doing so through the appropriate channels. It should be noted that not all of these concussion cases could be considered sport-related concussions. Additionally, the authors are only reporting on children with employer-based insurance, where similar trends may not occur with public sources of insurance like Medicaid or those with no insurance. Medical personnel should be aware of concussion laws and their states specificities to continue to increase awareness of concussion injuries and management.
Questions for Discussion: Did concussion laws help to increase concussion awareness? Is it easier to give concussion care and utilize health care insurance for concussions following the implementation of this legislation? Should education and management of other major injuries be regulated by legislation?
Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban