The cost of comorbidity to the Transport Accident Commission Compensation Scheme

Pre-existing medical conditions are known to affect length of hospital stay and mortality after trauma.Existing evidence is based mainly on short-term outcomes derived from hospital records, but less is known about the impact of pre-injury health on the cost of recovery beyond the immediate post-accident care period. Because the population is ageing and the road user population is likely to age at an even higher pace, the prevalence of chronic disease among TAC clients can be expected to increase. The aim of this study was therefore to determine the impact of pre-existing health conditions on the cost of recovery after compensable road traffic injury. In the pre-injury year, the 738 study participants used a total of 15,625 Medicare and 9,846 PBS items. In total 14.3 million AU$ was paid by the TAC to the participants in the post injury year. The modelling results showed that pre-injury health as identified by Medicare and PBS items had a relatively minor effect on the total TAC cost, with the exception of pre-injury mental health service use which was associated with increased total TAC cost. However, when considering individual TAC cost categories, several pre-injury health factors impacted recovery costs: particularly ambulance, hospital,medical and paramedical costs. Diabetes mellitus was associated with greater ambulance and hospital costs. Cardiovascular disease was associated with increased TAC medical costs and home services costs.Surgery in the year before the accident positively impacted post-injury hospital cost and home service costs.Back pain, indicated by pre-injury spinal X-rays and MRI, was associated with higher post-injury physiotherapy costs. And finally, mental health history, particularly pre-injury psychiatrist attendance and GP visits in relation to mental health, positively impacted total claim cost, administrative, income, hospital and paramedical expenses, especially when considered over the full post-injury year.