title: Seat belt use, insurance status, and hospital bad debt.
abstract: OBJECTIVE
  Previous studies have shown that not wearing a seat belt is associated with both increased injury severity and higher hospital charges. In this article, we examine whether unrestrained motorists are also more likely (a) to be medically uninsured, and (b) to leave their hospital bills unpaid.
  
  
  METHODS
  We reviewed the hospital clinical and billing records for all occupants in motor vehicle collisions admitted to the Massachusetts General Hospital Emergency Department during a 2-month period (n = 265). Using data on seat belt use, insurance status, bad debt, admission to the hospital, driver or passenger status, age and sex, we performed simple correlation and multiple regression analyses to determine the association between (a) seat belt use and insurance status and (b) seat belt use and hospital bad debt.
  
  
  RESULTS
  Unrestrained 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 studies that show that the public pays a significant share of the medical care charges associated with risk-taking behavior. Propitious selection, an economic theory, may explain such findings. It asserts that risk-taking individuals are least likely to buy insurance voluntarily and will also be the ones most likely to deliberately place themselves in dangerous situations. Our findings show that people who do not use seat belts are more likely to have outstanding hospital bills; the public effectively pays for these bills in higher taxes or insurance premiums.
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA.
authors.forename: A T
authors.initials: AT
authors.lastname: Clyde
authors.forename: D
authors.initials: D
authors.lastname: Hemenway
authors.forename: J T
authors.initials: JT
authors.lastname: Nagurney
mesh_terms: D000063:Accidents, Traffic / Q000191:economics* / Q000706:statistics & numerical data; D000328:Adult; D001900:Boston / Q000453:epidemiology; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000191:economics*; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012309:Risk-Taking; D012622:Seat Belts / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D017664:Uncompensated Care / Q000706:statistics & numerical data*