Effective Legislation Producing Realized Health Services

摘要

Public Law 104-166, more commonly known as the Traumatic Brain Injury Act of 1996 serves as a critical first step from a legislative perspective, in assuring that brain injuries are fully understood and treated in both an acute clinical environment and in the public health arena. And, through this discussion and research it will foster the discussion needed to understand its underlying causes, its overlying costs, and what can be done to prevent such tragic occurrences that affect the lives of so many Americans.This discussion analyzes the mechanisms and processes that were essential in the making of Public Law 104-166 through the legislative process. As with any law or rule, it is fundamental to understand whom it affects, and what it addresses, as well as the significance of the problem it attempts to influence. Traumatic Brain Injury (TBI) The incidence of traumatic brain injury in the United States consists of about one million people who are treated and released from hospital emergency centers, 230,000 people who are hospitalized and survive, and 50,000 people who die.1 The incidence rate of TBI (combined hospitalization and mortality rate) is 95 per 100,000 population, where 22% of those who suffer a TBI eventually die from their injury.1 Risk of TBI is highest among adolescents, young adults, and people older than 75 years of age.1 Leading causes of TBI include motor vehicle accidents, violence, and falls, though this varies by age where falls account as the leading cause in people 65 years of age or over, and transportation leads for people aged 5 to 64 years.1 Every year 80,000 Americans survive a TBI and are released from the hospital with a TBI-related disability, at last estimate there are 5.3 million Americans living with a TBI disability.1 TBI related injuries may result in impairment of: (1) cognitive abilities such as concentration, memory, judgement, and mood; (2) movement abilities including strength, coordination, and balance; (3) sensations such as tactile and special senses such as vision.1 There is limited available in terms of total monetary cost analysis of TBI in addition to the immeasurable cost borne by those suffering from TBI and the friends and family who must provide daily support. A 1985 study showed the total cost as $37.8 billion by combining direct annual expenditures of $4.5 billion and indirect annual costs of $33.3 billion.1 The National Center for Injury Prevention and Control (NCIPC) provides the following guidelines in its dealing with TBI as a public health problem1: Ongoing surveillance to follow trends in the incidence, risk factors, causes, and outcomes of these injuries through its Guidelines for the Surveillance of Central Nervous System Injury, a publication that sets forth standards and recommendations to improve coordination of central nervous system injury surveillance. The development of effective, science-based strategies to prevent the occurrence of these injuries. The development of more effective strategies to improve the outcomes of these injuries and minimize disability among those injured. In the NCIPC's 1999 report to the United States Congress it defined TBI as:an occurrence of injury to the head that is documented in a medical record, with one or more of the following conditions attributed to head injury: observed or self-reported decreased level of consciousness, amnesia, skull fracture, objective neurological or neuropsychological abnormality, or diagnosed intracranial lesion; or as an occurrence of death resulting from trauma, with head injury listed on the death certificate, autopsy report, or medical examiner's report in the sequence of conditions that resulted in death.2 The Legislative Process The legislative process is a complex multi-step and multi-tiered system of creating law. There are generally four methods in which Congress can initiate legislation: bills, joint resolutions, concurrent resolutions, and simple resolutions.3 Bills are the common form tha