Archive for January 16th, 2007

Veterans’ Health Issues: Catastrophic and Brain Injuries

January 16, 2007

Reports suggest it will take a concerted effort to address the health problems confronting our nation’s soldiers as they return from war. Their problems parallel some of the issues facing our overall health system, but in a more acute form. One such issue is catastrophic injury, and another is the complex world of brain injury.

It’s well known that advances in battlefield medicine have saved the lives of many soldiers whose injuries would have been fatal in earlier wars. This means that many of them are returning home with extremely severe conditions such as traumatic brain injury (TBI) and polytrauma (multiple severe injuries).

The presence of so many catastrophic injuries, many of which will require expensive initial treatment and lifelong care, raises concerns about the ability of the Veterans’ Administration to fulfill its duties. This issue has been raised in at least one study, by Harvard’s Kennedy School of Government(1).

Catastrophic injuries are a significant public policy issue in the civilian population, too. Data analysis studies I’ve conducted in the past for private health payers have shown that severe injuries range from 1% to 5% of total injuries or illnesses, but from 30% to 50% of total costs. These findings are generally consistent with other published studies. This suggests that proper treatment, funding, and planning for catastrophic care is a critical and under-recognized issue in health care policy.

As for non-catastrophic brain injuries, 1700 soldiers have been treated for TBI. Yet studies have shown that most wounded soldiers being treated in the US for any type of wound also show signs of TBI. (Specific figures: 60% of treated soldiers at Walter Reed Hospital and 83% at National Naval Health Center in Bethesda, according to two separate studies.) There is therefore a possibility that some TBI cases have not been recognized, since some symptoms can be difficult to distinguish from psychological trauma.

The misdiagnosis of neurological injury and illness can lead to prolonged disability, extensive and costly treatment for the wrong conditions, and other complications. This means that research into these types of injuries has potential benefit both for individuals and for the overall healthcare system.

In a related story, the Defense Appropriations Act of 2007 originally including reduced the annual research funding for the Defense and Veterans Brain Injury Center from $14 million to $7 million. After an outcry from veterans’ groups and others, the funds were eventually restored by politicians on both sides of the aisle.

The numbers suggest that research on brain injury is good public policy, as well as a way to support American veterans.

(1) Bilmes, L, Stiglitz, J. The Economic Cost of the Iraq War: An Appraisal.