title: Health care utilization and charges following the enactment of the 2007 Graduated Drivers Licensing Law in Massachusetts.
abstract: BACKGROUND
  Graduated Drivers Licensing (GDL) programs phase in driving privileges for teenagers. In 2007, Massachusetts implemented a stricter version of the 1998 GDL law, with increased fines and education. This study evaluated the impact of the law on motor vehicle crash (MVC)-related health care utilization and charges.
  
  
  METHODS
  Massachusetts government and US Census Bureau data were analyzed to compare the rates of MVC-related emergency department (ED) visits and hospital charges before (2002-2006) and after (2007-2011) the 2007 GDL law. Three driver age groups were studied: 16-17 (evaluating the law effect), 18-20 (evaluating the sustainability of the effect), and 25-29 years old (control group).
  
  
  RESULTS
  MVC-related ED visits per population decreased after the law for all three age groups (16-17: 2326 to 713; 18-20: 2110 to 1304; 25-29: 1694 to 1228; per 100,000, p<0.001), but the decrease was greater amongst teenagers (16-17: -69%; 18-20: -38%) compared to the control group (-27%); p<0.001. MVC-related hospital charges per population also decreased for teenagers but increased for the control group (16-17: $2.70 m to $1.45 m; 18-20: $3.52 m to $2.26 m; 25-29: $1.86 m to $1.92 m; per 100,000, p<0.001).
  
  
  CONCLUSIONS
  The 2007 GDL law in Massachusetts was associated with significant decreases in MVC-related health care utilization and hospital charges among teenage drivers.
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: nsangji@partners.org.
authors.forename: Naveen F
authors.initials: NF
authors.lastname: Sangji
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: eramly@partners.org.
authors.forename: Elie P
authors.initials: EP
authors.lastname: Ramly
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: hkaafarani@partners.org.
authors.forename: Haytham M A
authors.initials: HM
authors.lastname: Kaafarani
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. Electronic address: rseethala@partners.org.
authors.forename: Raghu
authors.initials: R
authors.lastname: Seethala
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: traybould@partners.org.
authors.forename: Toby
authors.initials: T
authors.lastname: Raybould
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: ccamargo@partners.org.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: gvelmahos@partners.org.
authors.forename: George
authors.initials: G
authors.lastname: Velmahos
authors.affiliation: Department of Pediatric Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: pmasiakos@partners.org.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Masiakos
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. Electronic address: lee.jarone@mgh.harvard.edu.
authors.forename: Jarone
authors.initials: J
authors.lastname: Lee
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D001334:Automobile Driving / Q000331:legislation & jurisprudence*; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D017722:Hospital Charges; D006801:Humans; D008004:Licensure / Q000331:legislation & jurisprudence*; D008404:Massachusetts / Q000453:epidemiology; D055815:Young Adult
keywords: Graduated Drivers Licensing laws; Health care costs; Health care utilization; Massachusetts; Teenage drivers