Seat Belts Payer

1
Estimated Medical Cost Savings from Standard Seat
Belt Law in Maine Impact on MaineCare,
Uninsured, and Commercial/Employer From the
Maine CODES (Crash Outcome Data Evaluation
System) Project
2
Who paid for the hospitalization costs for
unbelted drivers? Maine CODES data 1995-2001

• Unbelted occupants were more likely to be
  uninsured (20 vs 11) or covered by Medicaid /
  MaineCare (10 vs 6) than belted occupants.

Similar results were found in study by the South
Carolina CODES Project. The economic impact of
motor vehicle crashes the cost of restrained
versus unrestrained occupants in South Carolina.
Gill, et.al. Am. Surg. 2002. 68(6)569-74.
3
Summary

• States with standard seat belt laws have higher
  use rates compared to states with secondary laws.
  
• Maines seat belt use rate is lower than the
  national average.
• Previous Maine CODES studies show that in Maine
  seat belts reduced the risk of injury and cost
  associated with injury.
• Medical Cost Savings Study
• This study used statewide hospital data, Maine
  CODES data, and related references to estimate
  the potential impact of a change to a standard
  belt use law in Maine on medical costs.
• Results indicate a standard belt law would
• Over a five-year period 2005-2009, save 12
  million 3 million for MaineCare, 1 million for
  uninsured, 8 million for commercial / employer
  insurance.
• These results may underestimate the total medical
  cost savings when other factors are taken into
  consideration.

4
Medicaid / MaineCare Maine Hospital Use for
Drivers and Passengers in Motor Vehicle Traffic
Accidents Age 16 and Older (source MHDO data
files)
5
Commercial / Employer InsuredMaine Hospital Use
for Drivers and Passengers in Motor Vehicle
Traffic Accidents Age 16 and Older (source MHDO
data files)
6
Uninsured (Self-Pay)Maine Hospital Use for
Drivers and Passengers in Motor Vehicle Traffic
Accidents Age 16 and Older (source MHDO data
files)
7
2002 Hospital Use by TBI and Discharge
StatusMaine Hospital Use for Drivers and
Passengers in Motor Vehicle Traffic Accidents Age
16 and Older (source MHDO data files)
8
MaineCare Estimated 5-Year Medical Cost Savings
Resulting from Maine Standard Seat Belt Law
9
Maine Payer Summary Estimated 5-Year Cumulative
Medical Cost Savings Resulting from Maine
Standard Seat Belt Law
10
Methods

• Data Source
• Inpatient discharges and emergency department
  visits with ICD-9 Ecode indicating driver or
  passenger in motor vehicle traffic accident and
  age 16 or older. Source Maine Health Data
  Organization data files.
• Maine CODES (Crash Outcome Data Evaluation
  System) linked files
• Reporting
• By year, payer, primary diagnosis of traumatic
  brain injury (TBI), and hospital charges.
• Additional information used to estimates cost
  savings
• Belt use and relative risk of emergency
  department visit or hospitalization using Maine
  CODES analysis.
• Expected increase in belt use rate based on CDC,
  MMWR report.
• Post-discharge long term costs for TBI based on
  Craig Institute and Preusser Research Group, Inc.
  methods.
• Medical inflation based on BLS, CPI estimates.

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Estimating Cost Savings Data and Assumptions

• 2002 (most current MHDO complete year available)
  used as source
• Patient hospitalized with TBI will incur 40,348
  in addition to hospital cost during first year
  (Craig Institute)
• Patient hospitalized with TBI will incur 26,871
  during each subsequent year post-hospitalization
  and Medicaid will pick up additional cases of TBI
  in subsequent year resulting in a doubling of
  number of cases (Preusser Group). This applied
  to Medicaid/MaineCare only since TBI patients
  initially covered by commercial insurance or
  uninsured may have been covered by Medicaid /
  MaineCare during subsequent years.
• Seat belts relative risk of emergency department
  visit (0.84), non-TBI hospitalization (0.58), and
  TBI hospitalization (0.47) (source Maine CODES
  project estimates adjusted for other crash
  factors using logistic regression).
• Patients who died during hospitalization were
  reported separately and only there
  hospitalization charges included.
• Enactment of a standard belt law in Maine during
  2005 might increase belt use by 11 (CDC MMWR
  publication)
• Medical charges were inflated by 4 per year (BLS
  CPI data)

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Are these cost savings estimates too low?

• These estimates represent hospital charges and do
  not include the physician and other professional
  services, pharmacy, or dental costs that may be
  associated with these injuries during the first
  year and subsequent years.
• No subsequent costs for patients with emergency
  department visits or non-TBI inpatient
  hospitalizations were made. These patients may
  go on to have surgery or other medical care
  resulting from their injuries.
• These estimates assume that MaineCare and
  Uninsured have the same safety belt use rate as
  other Maine residents. If MaineCare and
  Uninsured have lower safety use rates, the
  potential for reduced injury rate and cost with a
  standard belt law might be larger for those
  residents.
• These estimates of subsequent medical cost
  associated with TBI may be too low. Brain
  injuries (TBI) are expensive and it is estimated
  that the lifetime 600,000 to 1.9 million (
  source NIH Consensus Panel on Brain Injury)
• Annual average cost for TBI patients could be
  determined directly from MaineCare claims data.
• A spill over effect on belt and safety seat use
  for children. About 14 percent of the MaineCare
  hospitalizations for traffic accidents were for
  children age 15 and under.
• Our inflation indicator for medical services was
  4 percent. This could be increased if we
  utilized the hospital service component CPI which
  is running at a higher percentage than
  professional services.

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References