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Type of insurance affects rehabilitation

Categories: Costs and Insurance

The Question

Does insurance type determine where one is placed for rehabilitation after traumatic brain injury (TBI)?

Past Studies

Past Studies found that economics and insurance coverage played a role in discharge decisions after stroke.

This Study

This Study: looked at 1271 people with brain injuries who were admitted to the King County Hospital in Washington State who were discharged to either a rehabilitation facility or to a nursing home. All of these individuals had insurance of one of the following types: fee for service (332), Managed Care (224) or Medicaid (715). Regardless of severity of injury and injury complications, people who had fee-for-service insurance were more likely to receive post acute care in a rehabilitation facility than people who used Managed Care or Medicaid. People on Medicaid were 68% more likely to be sent to a skilled nursing home than to a rehabilitation facility. Further, between 1993 and 1997, the years studied, the overall percentage of people being sent to nursing homes doubled (7% to 14%).

Who May Be Affected By This Study

People requiring inpatient rehabilitation services after discharge from a hospital.


While Managed Care patients were 23% more likely to be discharged to a nursing home than to a rehabilitation facility, the difference was not statistically significant. Because states administer their Medicaid programs differently, the same research may have different results in different states. In addition, these data are from a single hospital in a single state and the results might be different elsewhere.

Bottom Line

If decisions about rehabilitation placement are being made on the basis of economics rather than client needs, care may be negatively affected. More studies need to be done to determine if this occurs in other states and hospitals. Studies also need to be done to determine if placement has any effect on the long term outcomes of persons with TBI.

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Find This Study


Chan, Leighton; Doctor, Jason; Temkin, Nancy; MacLehose, Richard F.; Esselman, Peter; Bell, Kathleen; and Dikmen, Sureyya. “Discharge Disposition From Acute Care After Traumatic brain Injury: The Effect of Insurance Type”. Archives of Physical Medicine and Rehabilitation, vol. 82, Sept. 2001, pp. 1151-1154.