“Gaps in care” is one of the axioms used in the analysis of health-care quality. Kastenberg et al. have certainly identified such an issue regarding insurance coverage for spinal cord injury (SCI), at least as it pertains to the 2006 to 2010 time frame.

SCI is probably the most devastating nonfatal injury that we encounter in orthopaedics. State-of-the-art, intensive, acute care is required to optimize the outcome for all patients with SCI. However, the intermediate and long-term medical treatment and rehabilitation are equally important in determining the ultimate health status and function of those who are struck down by SCI. Thus, ongoing insurance coverage for the long term is a key component of maintaining health-care quality, and indeed quality of life, for the patient with SCI. The gap in care documented by the authors definitely represents a worrisome issue faced by patients with SCI and their families.

Unfortunately, the methodology utilized in the study does not allow determination of whether the lapse in insurance coverage was due to loss of employment (and therefore loss of the associated health benefits) or secondary to SCI alone. It is also not clear whether the patients were able to retain benefits through alternative coverage avenues such as the provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) or insurance from a spouse.