title: Experiences of pathways, outcomes and choice after severe traumatic brain injury under no-fault versus fault-based motor accident insurance.
abstract: OBJECTIVE
  To explore experiences of pathways, outcomes and choice after motor vehicle accident (MVA) acquired severe traumatic brain injury (sTBI) under fault-based vs no-fault motor accident insurance (MAI).
  
  
  METHODS
  In-depth qualitative interviews with 10 adults with sTBI and 17 family members examined experiences of pathways, outcomes and choice and how these were shaped by both compensable status and interactions with service providers and service funders under a no-fault and a fault-based MAI scheme. Participants were sampled to provide variation in compensable status, injury severity, time post-injury and metropolitan vs regional residency. Interviews were recorded, transcribed and thematically analysed to identify dominant themes under each scheme.
  
  
  RESULTS
  Dominant themes emerging under the no-fault scheme included: (a) rehabilitation-focused pathways; (b) a sense of security; and (c) bounded choices. Dominant themes under the fault-based scheme included: (a) resource-rationed pathways; (b) pressured lives; and (c) unknown choices. Participants under the no-fault scheme experienced superior access to specialist rehabilitation services, greater surety of support and more choice over how rehabilitation and life-time care needs were met.
  
  
  CONCLUSIONS
  This study provides valuable insights into individual experiences under fault-based vs no-fault MAI. Implications for an injury insurance scheme design to optimize pathways, outcomes and choice after sTBI are discussed.
authors.affiliation: a School of Nursing, Midwifery and Social Work, The University of Queensland , Brisbane , Australia .|b School of Allied Health, Australian Catholic University , Brisbane , Australia , and .
authors.forename: Rosamund
authors.initials: R
authors.lastname: Harrington
authors.affiliation: a School of Nursing, Midwifery and Social Work, The University of Queensland , Brisbane , Australia .
authors.forename: Michele
authors.initials: M
authors.lastname: Foster
authors.affiliation: c School of Health and Rehabilitation Sciences, The University of Queensland and Occupational Therapy Department, Princess Alexandra Hospital , Brisbane , Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fleming
mesh_terms: D000063:Accidents, Traffic / Q000191:economics; D000328:Adult; D001315:Australia; D001930:Brain Injuries / Q000191:economics* / Q000534:rehabilitation* / Q000628:therapy; D002755:Choice Behavior; D035881:Compensation and Redress; D005260:Female; D006801:Humans; D007346:Insurance, Accident / Q000145:classification / Q000191:economics*; D007351:Insurance, Liability / Q000191:economics*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
keywords: Automobile insurance; compensation; family outcome; lifetime care; motor accident insurance; motor vehicle accident; no-fault insurance; outcome; road traffic accident; traumatic brain injury