SEAT-BELT USE, INSURANCE STATUS, AND HOSPITAL BAD DEBT

Objectives: Previous studies have shown that not wearing a seat belt i s associated with both increased injury severity and higher hospital c harges, In this article, we examine whether unrestrained motorists are also more likely (a) to be medically uninsured, and (6) to leave thei r hospital bills unpaid, Methods: We reviewed the hospital clinical an d billing records for all occupants in motor vehicle collisions admitt ed to the Massachusetts General Hospital Emergency Department during a 2-month period (n = 265), Using data on seat belt use, insurance stat us, bad debt, admission to the hospital, driver or passenger status, a ge and sex, we performed simple correlation and multiple regression an alyses to determine the association between (a) seat belt use and insu rance status and (b) seat belt use and hospital bad debt. Results: Unr estrained patients were more likely both to be uninsured and, holding insurance status and other factors constant, to generate bad debt for the hospital, Conclusions: Our findings are similar to previous studie s that show that the public pays a significant share of the medical ca re charges associated with risk-taking behavior, Propitious selection, an economic theory, may explain such findings, It asserts that risk-t aking individuals are least likely to buy insurance voluntarily and wi ll also he the ones most likely to deliberately place themselves in da ngerous situations, Our findings show that people who do not use seat belts are more likely to have outstanding hospital bills; the public e ffectively pays for these bills in higher taxes or insurance premiums.