Concussion laws lead to increase in health care utilization

By Christine Baugh

Between 2009 and 2014 all U.S. States and the District of Columbia implemented concussion legislation. Generally modeled after Washington State’s Zachery Lystedt Law, most of these statutes require that youth and adolescent athletes are provided with information about concussions prior to sports participation, that they are removed from play if they are suspected of having sustained a concussion, and that they receive clearance from a medical professional prior to returning to sports participation. One of the main purposes of the Zachery Lystedt Law, and presumably those laws modeled after it, is to prevent the catastrophic neurological injury that can occur when a youth athlete returns to play too quickly following a concussion.

Gibson and colleagues recently published their study “Analyzing the effect of state legislation on health care utilization for children with concussion,” in JAMA Pediatrics. This study compared concussion care utilization for adolescents age 12 to 18 in states with and without concussion legislation using an insurance claims database. After controlling for potentially confounding factors such as median income and number of insured individuals per state, Gibson et al. found that states that had implemented concussion legislation had increased concussion care utilization (92% increase) compared to those without legislation (75% increase). The increases in care utilization were driven primarily by increases in visits to the doctor’s office and to a neurologist, not through increases in emergency department care, which the authors described as encouraging.

Gibson and colleagues appropriately point out that the increase in care utilization may be driven at least in part by improved public awareness of concussions and their health effects which is likely to be highly correlated with the implementation of state legislation. That is, until the population of a state feels that concussions are a health problem significant enough to warrant legislative intervention, laws will not be passed. Likewise, it is plausible that such an awareness would lead to increased concussion care utilization regardless of whether or not a law was in place.

Future research is needed to determine whether adolescent populations covered by public insurance schemes (e.g., Medicaid) were similarly affected by the implementation of concussion legislation, as the current study only included those with private insurance. Additionally, it will be interesting to see whether states that were late adopters of concussion legislation will have similar increases in care utilization following the implementation of legislation or if their care utilization increases will be delayed as was their legislative action.

Ensuring youth and adolescent athletes who are concussed receive health care is an important step, and one which the present study indicates has been positively affected by legislative action. However, concussion prevention is an equally if not more important public health goal left largely unaddressed by the current concussion laws.

[This post reflects my own views only.  It does not necessarily represent the views of the Petrie-Flom Center or the Football Players Health Study at Harvard University.]



At the end of her fellowship year, Christine Baugh was a PhD student in Health Policy at Harvard University. She received her BA in History and Science from Harvard College in 2010 and her MPH from Boston University School of Public Health in 2012, concentrating in Health Law, Bioethics, and Human Rights. At the time, Christine's primary research area was brain trauma sustained through sport, and she has written about the epidemiology, risk factors, policy approaches and implications, as well as the possible long-term effects of repeated brain injury. Broadly, Christine’s research interests involve the interaction between evolving science, policy, and society. While a student fellow at the Petrie Flom Center, Christine explored conflicts of interest in the collegiate sports medicine setting in a manuscript titled "Trust, Conflicts of Interest, and Concussion Reporting in College Football Players."

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